Trans Healthcare in Singapore
Singapore has two options for medical transition: public and private.
Private doctors are much more expensive, but may allow you to start hormone therapy (HRT) on the very first visit. Public hospitals require a longer process that may take months, but is significantly more affordable for consultation and medication. Public hospitals also provide a consistent level of high-quality care, including regular checkups and blood tests to ensure you are receiving your HRT in the most optimised manner. Some private doctors only provide blood tests upon request and tend to charge a lot more.
As medical transition is a big step, you may wish to consider first seeing a trans-friendly counsellor to talk through this decision in order to get a better understanding of your identity, your reasons for transitioning, the options available to you, and the steps you plan to take. This also helps you be clearer about what you are doing and why, and allows you to mentally prepare yourself for the challenges you may face on the journey ahead.
Note: Due to the pandemic’s strain on the healthcare system, many public hospitals are facing staffing challenges and this has resulted in longer waiting times than usual.
Public Healthcare: General Hospitals
In order to benefit from subsidised public healthcare, you need to be referred from a polyclinic instead of going directly to the hospitals.
Depending on your stage of transition, you will need a referral to either a psychiatrist or an endocrinologist.
If you have already been on HRT for while (e.g. over 1-2 years) or are transferring from a private doctor to the public healthcare system, you can ask for a direct referral to an endocrinologist. The polyclinic will refer you to Singapore General Hospital, National University Hospital or Changi General Hospital, depending on which cluster the polyclinic is in. All of these hospitals are led by excellent endocrinologists. The doctors at the public hospitals do work across departments, such as psychiatry and endocrinology, to provide more holistic care.
If you have just begun HRT (e.g. less than a year ago), it would be best if you have a psychiatrist’s diagnosis with you stating that you are transgender and giving approval for HRT. If not, you may still be able to get an endocrinologist referral, but you might also be required to see a psychiatrist first. This can unfortunately be subjective. There’s no clear line of how long on HRT is long enough.
If you have not yet begun HRT, you will need a psychiatric assessment and diagnosis before you can receive HRT. Let the GP know you are transgender, and ask for a referral to a psychiatrist at one of the Gender Care Clinics.
Gender Care Clinics
Singapore has two Gender Care Clinics: one at the Institute of Mental Health and one at Changi General Hospital. As of early 2022, the IMH clinic caters only to youths under 21. It is possible they may open to adults again in future. Adults are now referred to the CGH clinic.
If you’re not comfortable with outing yourself to the polyclinic GP, you can ask for a general referral to IMH or another public hospital’s psychiatry department (perhaps for depression, if applicable). However, we do not recommend this, as it will result in a longer waiting time and additional appointments. Due to staff shortages in the pandemic, in a worst case scenario it could potentially mean a year or two before you manage to get HRT. Should you require additional mental health support, you can instead bring it up when being assessed at the Gender Care Clinic.
The gender clinic only runs psychiatric services (diagnosis, check-ins, prescriptions), but will write a referral to an endocrinologist for hormone therapy, if that is what you want and you are assessed to be suitable for treatment. It has minimal gatekeeping, but they will counsel you if your reasons for wanting to undergo medical transition are unclear, or if there may be other issues you might want to work through first. They will not advise any kind of conversion therapy, and are supportive and sensitive. The doctors at IMH work in tandem with endocrinologists at Tan Tock Seng Hospital to administer HRT, while the CGH clinic works with the CGH endocrinologists.
If the hospital locations are inconvenient for you, you can try asking for a referral to an endocrinologist at NUH or SGH instead. We do not currently know of people who have switched over, but both NUH and SGH do provide comprehensive HRT services for trans people.
At the Gender Care Clinic, you can expect to have at least two appointments. However, this is very much on a case-by-case basis; it is possible that you may be referred for HRT after just one appointment, or you may require several additional appointments if you are unsure about the transition steps you wish to take and need more time to talk it through, or if you have additional mental health or personal considerations that could impact your transition.
Transitioning as a Minor
If you are under 21, you will need both your parents’ consent to start HRT. This applies even if your parents are separated, though exceptions may be made for extraordinary circumstances. HRT is not available in the Singapore public healthcare system to those under 18.
If you are presently enrolled in a local school, do be aware that trans students typically face immense challenges within the school system and are unlikely to be accommodated on issues of uniform and toilet access. You may thus have to consider options such as withholding transition until after you graduate, living as your gender only outside of school contexts, or going on HRT without social transition. (e.g. if you are a trans male student, that would mean going on T but continuing to wear the girls’ uniform and presenting as female while you are at the school. In some cases, trans people find that HRT eases their physical dysphoria enough to make social dysphoria more tolerable, although the opposite could also be possible.)
International schools are usually known to be more accommodating and even strongly supportive of transgender students, but this differs from school to school.
Those under 21 will typically have a longer and more stringent assessment process when seeking HRT through the public healthcare system. We advise you to be mentally prepared, as well as not to hold off too long if you know that you will be transitioning eventually.
Singapore has several private clinics that provide transgender healthcare services, including HRT. These usually cost quite a lot more than public hospitals, but have a much shorter waiting time. If privacy is a concern, especially if you are visibly trans and afraid of harassment, you may also be more comfortable visiting a small clinic rather than a hospital.
You can email us for more information.
Mixing Public and Private Routes
Some people may choose to first see a private doctor to begin HRT while waiting for their appointment at a public hospital. If you are struggling badly with dysphoria and are desperate, this is something you can consider if you are able to afford the cost. (A first consultation might be around $200 for private, vs about $40 for public.) We nonetheless recommend shifting to the public route eventually as the difference in costs will add up and can be immense over the long run.
Alternatively, you can choose to visit a private psychiatrist for an assessment and diagnosis, and then bring that letter to a polyclinic and get a direct referral to a public hospital endocrinologist.
This can help you skip the long waiting and assessment times of the public route. However, private psychiatrists also vary greatly in their expertise and knowledge of trans identities, which can be a concern if you are unsure about transition being right for you and wish to explore it further before making a decision. If that is the case for you, you might want to speak with a counsellor first.
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(at)gmail.com.