In China, where no official numbers of transgender people exist, there are few medical facilities that offer gender reassignment surgery and little professional information on hormone treatment, forcing people to turn to the black market or online
Chengdu (China) (AFP) - Vulnerable and afraid, a 16-year-old boy sat on the floor of his home in rural eastern China and tried to hack off his genitals with a scalpel, an act of desperation against a body he did not want.
Too scared to talk to family in a society that still classifies transgender people as having a "mental illness", instead he attempted surgery on himself after watching online tutorials of the procedure.
He wasn't able to go through with it and stopped after the first painful cut -- but he didn't go to the hospital or tell anyone what he had done.
Now aged 23, that boy identifies as Alice, and concedes it was a dangerous, potentially fatal, move.
"I was desperate and scared," Alice told AFP, adding: "It was this feeling in my stomach that I had to get it over and done with."
In China, where no official numbers of transgender people exist, there are few medical facilities that offer gender reassignment surgery and little professional information on hormone treatment, forcing people to turn to the black market or online.
People are unable to have gender-reassignment surgery without the legal consent of their families, and many are reluctant to discuss the issue with their family -- for fear of being ostracised or disowned.
Even for those who are brave enough to raise the topic with loved ones, it can be hard to get agreement for medical treatment.
"It was a worry, it ate me from the inside," recalled Alice, who now uses the pronoun "they".
- 'Risk their lives' -
A report earlier this year from Amnesty International found there was prevalent discrimination, restrictive eligibility requirements, and a lack of information in China.
This combined with the expense -- hormonal medication costs as much as ten percent of the average monthly salary in China -- has left many transgender people to seek unregulated, risky treatments, or attempt dangerous self-surgery.
"Discriminatory laws and policies have left many people feeling they have no choice but to risk their lives by performing extremely dangerous surgery on themselves and to seek unsafe hormone drugs on the black market," said Doriane Lau, China researcher at Amnesty International.
"The highly-restrictive requirements for accessing gender-affirming surgeries and lack of health-related information needs to change so people can access the health care they need," Lau added.
One trans man, Jiatu, told AFP he felt uncomfortable in the body he was given at birth and began his treatment three years ago, getting his testosterone injections from Thailand illegally.
"There is no other way to get it. You learn all this through 'brothers' online," he said, referring to other transgender men who share their experiences in online discussion groups.
- 'Empower next generation' -
Jiatsu's situation is not uncommon: Amnesty's report featured testimony suggesting information was often found online or through friends in similar situations, and that doctors in the public health service were not able to offer the right support.
The Chinese government accepted recommendations by the UN Human Rights Council to ban discrimination against LGBTI people in March, and the World Health Organization officially removed "gender identity disorder" from its global manual of diagnoses in May.
Alice, who now does advocacy work, said Chinese society's conservative attitude towards LGBT groups, especially trans people, means the government is slow to change its policies.
"Right now is not a good time, what the government can do has limitations due to society’s current views," Alice explained, adding: "We need to wait until the next generation to be empowered, then things will get better."
Alice had surgery to remove the male sexual organs in Thailand last year -- circumventing China's requirement for family permission by having the procedure abroad.
It was a gift from a girlfriend which cost more than 90,000 yuan ($12,600).
"It feels more natural, extremely good. My head space and emotions are much better, in fact, a lot of things for me became much more open," Alice said, of life post-surgery.
"It was a really good thing -- (gender identity) is not always black and white."