Trans Healthcare in Singapore

Singapore has two options for medical transition: public and private.

Public hospitals require a longer process that may take weeks to months. However, it is significantly more affordable for consultation and medication. Public hospitals also provide a consistent level of care, including regular checkups and blood tests to ensure you are receiving your hormone replacement therapy (HRT) in a safe and optimised manner.

Private doctors are much more expensive, but may allow you to start HRT with informed consent on the very first visit. Some private doctors only provide blood tests upon request and tend to charge a lot more. Consultations can cost upwards of $200-300 for a private doctor and $40-50 at a public hospital.

For both the public and private routes, you will typically have to see two specialists – a psychiatrist and an endocrinologist – in order to access HRT.

As medical transition is a big step and can be very stressful, you may wish to consider seeing a trans-friendly counsellor to talk through this decision. This can help you get a better understanding of your identity, your reasons for wanting to go on HRT or for surgeries, the different options available to you, and the steps you plan to take. This helps you be clearer about what you are doing and why, be sure of your decision, and prepare yourself for the challenges you may face.

Ideally, you should also try and find a support network so that you have friends to lean on when times get tough, especially if your family is not supportive.

What each specialist will do

The public healthcare route

Singapore Citizens and PRs receive subsidised public healthcare when referred through a polyclinic.

If you are above 18 and wish to transition under the public healthcare system, or want a formal evaluation and diagnosis for gender dysphoria through the public healthcare system, your first step will be to make an appointment with a polyclinic.

If you are not a Singapore Citizen or PR, you should instead make an appointment directly with a psychiatrist, where you would be considered a private patient. (This is more costly, but typically still cheaper than seeing a private psychiatrist.)

Find out more about transfeminine HRT and transmasculine HRT.

If you are below 18, your options are drastically more limited as HRT is generally not prescribed to those under 18 through the Singapore public healthcare system. Click here for more information.

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What to expect at the polyclinic

• When you arrive, the receptionist may ask what you are seeing the GP for. If you are unwilling to out yourself to the receptionist, you can say that you’re there for depression or anxiety. Their main concern here is that you are not undergoing a medical emergency or are contagious (e.g. with COVID-19).
• Inform the GP you are transgender and ask for a referral to a psychiatrist for gender dysphoria. A psychiatric evaluation is needed before HRT can be prescribed.
  • If you already have a diagnosis from a private psychiatrist OR have been on HRT for a considerable amount of time (e.g. more than 1-2 years), you can ask for a referral to an endocrinologist instead.
  • Indicate whether you have been on HRT, and for how long. This will help in determining how urgent an endocrinologist appointment will be.
• Depending on the polyclinic and healthcare cluster, you should ask for a referral to the following hospitals:
  • Khoo Teck Puat Hospital (KTPH) if you live in the Central region, close to a National Healthcare Group polyclinic.
  • National University Hospital (NUH) or Ng Teng Fong General Hospital (NTFGH) if you live in the West, close to a National University Health System polyclinic.
  • Changi General Hospital (CGH) or Sengkang General Hospital (SKH) if you live in the East, close to a SingHealth polyclinic. (CGH requires you to see a psychiatrist before HRT can be prescribed.)
  • You can check which cluster each polyclinic belongs to on the polyclinic appointment website or on the list above.
• The GP will then refer you to a psychiatrist or endocrinologist at that hospital. They will not be evaluating you for gender dysphoria, but may ask some short questions for their referral notes.
  • If you are not comfortable outing yourself to the polyclinic GP, you can ask for a general referral to a psychological medicine department citing depression or anxiety. However, do note that this may require more appointments and prolong the time before you can access HRT. Many trans people have gone through the polyclinic system, so most GPs are familiar with the process.

What to expect when seeing the psychiatrist

• The psychiatrist will ask you some questions about your gender dysphoria and trans identity, as well as your plans for transition.
  • This may include questions about your life, when you realised you were transgender, and perhaps more stereotypical questions like what sort of toys you played with as a child. Depending on the psych, be prepared that some questions may be sexual in nature, though this is rarer these days.
• It is possible to be approved for HRT after just one appointment, but it is common to have two or more sessions if you are young or the psychiatrist deems you unsure about the transition steps you wish to take. Additional appointments may also be needed if you have additional mental health or personal considerations that could impact your transition, e.g. severe depression or lack of support system.
• When the evaluation is complete, the psychiatrist will give you a memo with a formal diagnosis of gender dysphoria based on their assessment, and refer you to an endocrinologist if you wish to pursue HRT.

What to expect when seeing the endocrinologist

• Bring along your transition-related documentation such as psychiatrist memos, any overseas psychiatrist evaluations, private HRT prescriptions or any logs may have kept for self-managed HRT.
• The endocrinologist will do a preliminary evaluation for related health risks from HRT, based on your personal and family medical histories.
• The endocrinologist will also ask you some questions relating to your gender dysphoria, and may refer you to their psychiatrist for a fuller evaluation.
• The endocrinologist will send you for baseline blood tests to check your sex hormone levels and liver and kidney function. This is important, as it will help determine if any future medical abnormalities are due to HRT or pre-existing medical conditions. Some hospitals additionally require bone density scans.
• You can also ask for additional referrals to a speech therapist or a psychologist.
  • Any additional referrals should be registered for you 2-3 working days from the end of your first visit.

The private healthcare route

Singapore has several private clinics that provide transgender healthcare services, including HRT. These cost significantly more than public hospitals, but have a shorter waiting time and provide a more discreet experience.

General practitioners

There are a small number of private GPs that prescribe HRT under informed consent.

However, they are not psychiatrists and thus will not be able to diagnose you with gender dysphoria, which you will need if you plan to transfer to the public healthcare system or if you require accommodations with regards to schooling or National Service (NS).

Private psychiatrists

Private psychiatrists can evaluate you for gender dysphoria and write a memo with their diagnosis. You can use that diagnosis to see a private or public endocrinologist for HRT. Do note that private psychiatrists differ widely in their experience with trans issues, which can be a concern if you are unsure about transition being right for you.

Private endocrinologists

Private endocrinologists require a psychiatrist’s memo in order to prescribe HRT. They can also administer blood tests.

You can email us at contacttransgendersg@gmail.com for recommendations and more information.

Mixing public and private routes

Some people may choose to begin HRT through the private route while waiting for their appointment at a public hospital. This can be a good option if you can afford it and would prefer not to wait, or want a more discreet experience.

We do recommend shifting to a public route eventually as the difference in cost will be immense over the long run. The public route also ensures that you will have continuous care for the rest of your life, rather than risk an interruption if the private doctor suddenly quits or retires.

With most hospitals, an assessment from a private psychiatrist can be used to obtain approval for HRT at a public hospital endocrinologist. (Changi General Hospital is the only exception as they do their own internal assessments.)

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Due to the sensitivity of the information involved, feel free to contact us if you wish to find out more about pursuing transition via the public healthcare system. You can reach us by email at contacttransgendersg@gmail.com.