SEPTEMBER 17 — "Maaflah terlupa apa nak kata, makan banyak sangat hormon,” I kept recalling the joke made by one of the trans activist in Malaysia as I started to become more entrenched within the interaction I have with the trans community.

Hormone plays a significant role in the formation of trans livelihood. For transwomen, apart from the sexual reassignment surgeries, hormone replacement therapy is a journey to be embarked in the strive for feminisation.

I sat down with the social workers of SEED Foundation as I started to become more interested in the condition of the soft white underbelly of Kuala Lumpur.

They recollected the tales of abuse faced by sex workers, the death of trans individuals by heartbreaks and at the hands of vengeful lovers and the rise in the usage of drugs by youth of the city due to an ominous yet systematic operation of the underground gangster conglomerate.

As our conversation got a lot livelier, I was enticed by the topic brought up by them on trans individuals which is transwoman’s usage of hormones to achieve femininity.

Sexual reassignment treatment is a delicate matter. While surgeries are the primary issue often brought up in discourse on sexual reassignment treatment, hormone replacement therapy is as significant in the construction of trans self-esteem. What is rather unfortunate is that the handling of hormone replacement therapy in Malaysia is dire.

In the recent times, many of the hormone medications transwomen relied on had been discontinued by the Malaysian government. Medication such as anti-androgen used by prostate cancer patients to contain the growth of cancer have also been used by transwomen to contain their testosterone production.

Subsequently, male secondary sexual characteristics such as facial hair which is not necessarily wanted by them can be reduced.

Alternatively, although it is not optimal, underprivileged transwomen will also opt for birth control pills. Transwomen are aware of oestrogen’s effect and its usage as a form of hormone replacement therapy for male to female trans individuals.

However, due to the shortage of its access in Malaysia, many of them turn to birth pills with the hope that the content of oestrogen within the pills will have the same result. It should be noted that birth control pills are not indistinguishable from prescribed oestrogen as a therapy and medication.

The differences in content combination and dosage is a signifier in the differences in usage. But without the availability of the hormone therapy itself, precautions are often not given prioritisation.

The lack of access and care for trans individuals particularly within the scope of health and wellness birthed a detrimental capitalistic climate for them. Private clinics in areas with a heavy concentration of trans individuals particularly the underprivileged trans individuals will often provide illegal hormone injections.

Nonetheless, such clinics are purely for-profit as they may not provide the necessary blood test to monitor the compatibility of the hormones with the trans individuals. The intensive blood monitoring may be provided by private hospitals although for many trans individuals, it is not quite affordable.

The health authorities of the private hospitals do include written prescription for the needed hormones but do not provide the hormones themselves.

Surprisingly, hormones are available at ease through 15 ringgits pills obtainable through mainstream online market. Shipped from the motherlode of genericity, labelling of the pills are of unidentifiable Chinese scripts that even Chinese individuals consulted by the trans individuals to translate failed in understanding.

Consumption without knowledge will inevitably bear fruit. In a few weeks, the transwomen will do form breasts and their hips will be more rounded per wishes, but in many cases, the same individuals will develop complications.

Without intensive monitoring of blood test, trans individuals consuming the hormone pills on their own compliancy resulted on the weakening of their bones and for the few of them that smoke, they will face an increased risk of developing cardiovascular complications and even worse, death.

Discrimination against trans community is not limited only to through the projection of hate crime and legal issues. When trans individuals are not given much prioritisation within the realm of health on trans specific issues, they are subjected to a systematic oppression that will lead to the deterioration of their condition.

Should they be left to their own devices on formulating the ways to help themselves, the nation is responsible for the crime of neglection.

Advocacy for the rights of trans community will always include the right for trans individuals to receive treatment and therapy as a reflection to the visibility of them as a valid gender identity.

Until then, semoga kita terus berbakti.

* This is the personal opinion of the writer(s) or organisation(s) and does not necessarily represent the views of Malay Mail.