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 on the very first visit. Some private doctors only provide blood tests upon request and tend to charge a lot more.
(An example of the cost disparity would be consultations costing around $200-300 for a private doctor and $40-$50 at a public hospital.)
As medical transition is a big step and can be very stressful, 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.
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.
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 an appropriate public hospital. Should you wish to seek healthcare with a specific doctor or at a specific hospital different from the one they refer you to, you will need to make an appointment as a private patient, and will not be eligible for subsidies.
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. You will be referred to the psychiatric department at a public hospital or the Institute of Mental Health (IMH), all of which see transgender patients.
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. Should you require additional mental health support, you can instead bring it up when being assessed by the psychiatrist.
When seeing the psychiatrist, 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 boy, 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 happen.)
International schools are usually known to be more accommodating and even strongly supportive of transgender students. This nonetheless differs from school to school.
Those under 21 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 are certain 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 to consider if you can afford it. We nonetheless recommend shifting to the public route eventually as the difference in costs will 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.
Both public and private private psychiatrists vary 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 firstname.lastname@example.org.