Every Week They Listen to Transgender Callers From Across China. They're Called "Transgender Hotline Operators"

The questions tend to cluster around a few themes: anxiety over gender identity, sexual orientation, coming out to family, getting medical care and hormones, and work.

"Some people think that once I lie down on the operating table and pay, the problem is solved. And it's true that for some people, lying down and paying really does solve it. But those two things aren't quite the same."

Zhang Yushu, 39, is a transgender woman (someone assigned male at birth who identifies as female, also called MTF). She is married with a son, spends most of her time in Liaoning, and travels now and then to Beijing to stay at her girlfriend's place.

Three years ago she joined the Transgender Hotline as one of its first operators, when there were only four of them. It is China's first hotline service for transgender people, and the operators' job is to listen every week to the questions of transgender people from across the country and, where possible, offer answers. Before that, she had already been doing similar "service" work online for years.

In 2011, Zhang Yushu took the first step of gender reassignment surgery, an orchiectomy. She said it felt like "a stone that had been pressing on my chest for decades suddenly dropped away."

Do medication and surgery solve a transgender person's life? Zhang Yushu used her own body to find out.

The surgery did bring her happiness, but it did not dissolve the anxiety she had carried for years. "There will always be problems," she said. Surgery, she believes, means something different to each person. "Why did I have surgery? Because male hormones affected me a lot. One obvious sign was hair loss, my hairline moving back. Surgery could stop that. Think about it: no matter how much I felt like a woman, if I went bald, I really couldn't have borne it."

Having had the surgery herself, she stressed, does not mean she encourages anyone else to have it. "A decision this irreversible has to be thought through and made by the person themselves. Some people are still anxious after surgery — partly the problem of fitting into society, partly the daily friction at home. Take transgender men: they grow up surrounded by girls their whole lives, so they simply don't know how men's social circles work."

Zhang Yushu now also works with the parents of transgender people. In her view the parents' problems matter as much as the children's, and surgery is exactly where transgender people and their parents clash hardest.

After years of this work, two situations still cause her pain. One is an adult whose depression is bad enough that they cannot live or work normally — and whose family does nothing about it. The other is a child and their parents whose conflict keeps escalating until the child takes their own life.

"On average someone in the community takes their own life every month — some I know, some I don't. It's all negative energy, but if I can see that this [the hotline] helps some people, there's still a positive side." Zhang Yushu said the operators themselves badly need psychological support too.

Earlier this year she left the Transgender Hotline, stepping out of the ranks of working operators into a supporting role. A number of new people joined this year, she said, which felt like a healthy cycle. By the start of this year she had spent about two and a half years as an operator.

2.

"First, an operator has to be transgender themselves, and has to know themselves well. Do you want to be a woman (or a man)? Or do you want to be a certain kind of woman (or man)? Those are two different states."

Lu Ping, also a transgender woman, joined the operators only this March and is now in charge of launching and running the Beijing LGBT Center's "National Transgender Hotline." Eight operators are currently taking calls, she said.

The "National Transgender Hotline" grew out of the Beijing LGBT Center's earlier "Transgender Hotline." This August the center pulled together similar services from around China — among them the Trans Center's psychology team, the Anhui Wan'ai LGBT group and the Trans Youth Education Center — to launch the national line together.

Lu Ping is only 21, but she has already been through nearly every difficulty a transgender person can face: gender identity anxiety, hormone therapy, depression, a failed coming-out, running away from home, dropping out of school.

In 2003, in a small town in Chongqing, six-year-old Lu Ping was playing outside her aunt's house with her cousins and got her clothes dirty. Her aunt had no boys' clothes on hand, so she put Lu Ping in a cousin's clothes instead. Looking at herself in girls' clothes in the mirror, this six-year-old "boy" felt something stir that she could not put into words.

Then a boy from the neighborhood walked past and saw her. "I still remember the way he looked at me, a little shy, the way he'd look at a girl. I really enjoyed being taken for the opposite sex."

After that, Lu Ping would put on skirts, stockings and high heels whenever her mother was out. But as her secondary sex characteristics came in, she found she fit those clothes less and less well. "Later I was never satisfied when I looked in the mirror. I felt I wasn't pretty enough, wasn't enough like a girl. That's what anxiety is. You'll notice transgender women often compare looks, competing over who is more 'like a girl.' That's where a lot of people's anxiety comes from."

These days Lu Ping seems more and more able to live with the person in the mirror, even if that is not the version of herself she thinks is best.

When she was interviewed at the Beijing LGBT Center on September 23, she wore a T-shirt and loose jeans, her medium-length hair tied into a simple ponytail with her bangs brushed back. The look was so unlike the feminine one in her WeChat profile photo that she could have been two people. She laughed and said today's outfit made her look like a National Geographic photographer: "The skirt I like isn't dry yet, and my backpack today is on the masculine side, so an androgynous look suits it better."

Lu Ping is being treated at Peking University Third Hospital and takes hormones regularly. Estrogen has done some work on her body, she said; one obvious change is that her muscle is distributed differently than before, and her explosive power and strength in sports are not what they were.

She had been studying food science at Beijing Forestry University. In her third year she came out to her family with a hospital diagnosis of "gender identity disorder," but they could not accept it — her father even hit her. In the end they gave her a choice: stay home as a man, or leave the family for good.

Leaving home meant dropping out of school. Money was tight in that period, but new media work connected to gender advocacy got her studying gender issues. "What I have to deal with now is how to be a person, not how to be a woman. I need to think about building up my professional skills. All of that comes before surgery. I'll definitely do it, but it isn't that high on the list."

Lu Ping thinks today's social climate does put real survival pressure on transgender people, but that is only one side of it. She has noticed something else: some people pin every failure and disappointment in their lives on their gender. Whether a bad outcome is actually caused by gender varies from person to person.

3.

"I've liked girls and I've liked boys. The confusion scrambled my sense of who I was, but in the end I realized that whatever else was true, I wanted the other person to see me through a woman's eyes."

Wang Xiaoyang, 23, is also a transgender woman. She is from Hebei and worked as an operator for about two months, leaving the line in September.

In her first year of middle school, Wang Xiaoyang found that nothing aimed at boys interested her, while women's things caught her attention. She started reading online, gradually learned what being transgender meant, then bought hormones on her own and took them for a while. Because she took them during puberty, she felt the changes in her body clearly.

What confused her more was that she also fell for women, which made her question her identity on the basis of her sexual orientation. "It wasn't until high school that I went through a phase of trying to correct myself. I had a few girlfriends. I did like them, but I didn't like them the way a man does, and I could never be truly intimate with them."

Having girlfriends spared her some of the discrimination and bullying at school, but the gap between her sexual orientation and her gender identity still made adolescence very hard.

In her first year of college, Wang Xiaoyang fell for an older student. Again she turned it over: was she a gay man drawn to him as a man, or was she something else? In the end she realized that whatever else was true, she wanted him to see her through a woman's eyes.

The crush went nowhere. With no community around her at the time and the emotional blow on top of it, Wang Xiaoyang admits she thought about killing herself during college and made an attempt. Surviving it made her reconsider: she had not yet made any real effort to change her life.

Recently, because of her family, Wang Xiaoyang left Beijing briefly for her hometown in Hebei. The conflict only got worse once she was back, so she had to put distance between them again and moved back to Beijing.

On September 22, Wang Xiaoyang turned up at the CapitaMall by Beijing's Wangjing Station in a black fitted T-shirt with a Hello Kitty logo, dark blue jeans and a crisp short haircut — a relatively androgynous look.

Her skin is very fair, and that day she had put on pinkish-purple eyeshadow, pale pink lip gloss and pink glitter nail polish. The ideal woman in her mind, she said, has the androgynous, easy style of Guey Lun-mei. "Honestly, when I dress as a woman now, people on the street don't take me for a man anymore."

Wang Xiaoyang says she does not expect her relationship with her family or with society to improve much any time soon. "Finding a balance with society matters. Taking society on head-on takes courage, but not everyone is willing to do that, or able to."

4.

In 2017, Peking University's Department of Sociology, the Beijing LGBT Center and the United Nations Development Programme ran a joint study, Survey on the Living Conditions of China's Transgender Community.

The report sketches a baseline picture of transgender people in mainland China. As of September 2017 it had collected 5,677 questionnaires, 2,600 of them valid. Among respondents, transgender women made up 33.7%, transgender men 30.9%, genderqueer people 26.4% and cross-dressers 9.0%.

Nearly 67.6% of respondents said they had at some point strongly hated the sex they were born with, and 72.8% said puberty brought them intense pain and anxiety.

More than 90% of transgender people's families do not accept that their child is transgender. Of the 853 respondents who had come out to their families, 38.9% had parents who rejected it outright, 36% partly accepted it, 14.2% had one parent who could accept it, and only 10.9% had families that accepted it fully.

Because families of origin so often offer no support, and the wider social system offers transgender people little backup, more than 40% of respondents who had suffered violence in one situation or another never sought help of any kind.

Dr. Pan Bolin of Peking University Third Hospital said the hospital currently sees about 20 transgender outpatients a week. As for gender reassignment surgery, it performs somewhere in the low teens of cases a year; over the past three years that averages out to about 15 surgeries a year.

"In our medical language this is called transsexualism — what people commonly call being transgender," Pan Bolin said. Any transgender person who wants hormones or surgery, he stressed, must first meet the diagnostic criteria for transsexualism, and that diagnosis usually has to come from a psychiatrist.

Pan Bolin explained that treatment for transsexualism runs in three stages: psychological support, hormone therapy and gender reassignment surgery. Not every transgender person reaches the last stage; plenty of practical factors get in the way. For anyone who does reach "gender reassignment surgery," he recommends at least five years of psychological support beforehand and more than a year on hormones as a transition period, "because gender reassignment surgery is irreversible, it is destructive, and it carries a risk of complications."

Minors can be seen at the transsexualism clinic, but under Chinese law a person must be at least 20 to have surgery in China.

Pan Bolin has found that the biggest obstacle for many transgender people is the strain in their family relationships. If parents will learn about the condition alongside their child, he believes, it does a great deal to ease the child's anxiety. He added that within transgender care in China, the "psychological support" piece really does lag behind other countries, especially those in North America and Northern Europe — and it is a crucial piece.

That gap is exactly what the transgender hotline hopes to help fill.

Zhang Yushu says the Transgender Hotline is not professional psychological counseling; what it mainly provides is peer care and community support. Lu Ping adds that most people rarely meet another transgender person in daily life, so many feel they are the only transgender person in the world.

By the hotline's own count, more than 300 people called last year, roughly one a day. Plenty of them were minors — the youngest was 13 — and many were going through the same confusion the operators had once worked through, or were still working through.

Zhang Yushu stresses that an operator who empathizes with every caller on every problem piles up an enormous amount of negative energy: you may have lived through each of these things yourself, and it is like going through them again. For her, most problems are better met with something concrete. "The only way you really help someone is by giving them a solution. Comfort on its own means nothing."

5.

Drawing on these operators' own lives and their time on the line, QDaily has also put together a few of the questions Chinese transgender people most often face:

Q: Am I transgender?

Lu Ping: A lot of callers open with "Do you think I'm transgender?" It's the question we get most. The first thing we usually do is explain what "gender identity," "sexual orientation" and "gender expression" mean. And one point matters a great deal: gender identity is for the person themselves to determine, not for anyone else to judge.

We aren't in a position to make that call, and we're against operators judging callers directly. If you're transgender, you're the one who says so — whatever gender you feel yourself to be inside, that is your gender. Being transgender means your gender identity and gender expression differ from the sex you were born with.

Then there are people who ask, "I feel fine as a boy and fine as a girl — what does that make me?" That's a different concept, "genderqueer": an identity beyond the male-female binary. In other words, you can be 80% woman and 20% man. What matters is which state feels most comfortable to you; that's the state that fits.

*Note: Gender Identity refers to a person's emotional and psychological sense of belonging to a particular gender. Gender Expression refers to the outward ways a person expresses their gender, through dress, speech, behavior and so on. Sexual Orientation refers to a person's enduring sexual and emotional attraction to people of a particular gender.

Q: Does liking women's clothes make someone transgender?

Lu Ping: We separate two concepts: "transgender" and "gender-nonconforming (cross-dresser)." A cross-dresser is someone who likes wearing the clothes and styles of the opposite sex but does not want to live as that sex. The fundamental difference between a cross-dresser and a transgender person is that the former identifies with the sex they were born with.

Q: Should a transgender person use the men's or the women's restroom?

Zhang Yushu: With the bathroom problem, nobody agonizes for more than 10 minutes. You have to decide within 10 minutes, because what else can you do? What I usually tell people is: whatever you look like, if your ID says male, using the women's room could be illegal. Whatever you're wearing, nobody is going to drag you out of the men's room. All I do is tell callers there's a risk.

Lu Ping: In a public restroom I think you should take other people's feelings into account as much as you can. I'll usually use the restroom that matches how I'm dressed that day. But even in the men's room I'll use a stall. I care a lot about my privacy.

Q: How should I come out to my family?

Lu Ping: We usually give callers a coming-out handbook. Coming out isn't something that happens at once; it's a long process. A lot of people think, "I'm coming out tonight, and if you won't accept it, I'll threaten to end it all." Even in my case it took at least a year to slowly win my parents' acceptance. Views that deep in parents don't change overnight, so you have to be patient. The great majority of Chinese parents can come to "understand," even if they don't necessarily accept.

We generally advise callers to become financially independent first. If they can't yet, they have to go gently. And if your parents might beat you or kill you after you come out, do you have somewhere to go? Nanjing, for instance, has a transgender shelter that provides temporary safe space for transgender people facing domestic violence.

Q: Should I take medication? Should I have surgery?

Lu Ping: Two things set transgender people apart from other groups in the LGBT community. A gay person doesn't have to come out to coworkers and family that early, but a transgender person who wants to be themselves has to come out to the people around them. On top of that, transgender people have medication and medical needs the other groups don't.

We're fairly strict about medical questions. If someone asks about this, we tell them what conditions they have to meet to take hormones legally in China. We can't tell them how to take them, but we will tell them where to get medication through proper channels, and what the risks are of going outside those channels — buying on Taobao, for instance. We also tell them what they risk if they don't get regular checkups.

Pan Bolin: For a transgender woman, the hormones involved are anti-androgens and estrogen. But because taking hormones requires a transsexualism diagnosis and other conditions, a fair number of people currently buy their medication online.

Long-term hormone use does have side effects: damage to liver and kidney function, for one. Estrogen can also affect blood-clot formation, or cause abnormal blood sugar or blood lipids. To avoid those risks we usually recommend a checkup every three months, and cutting the dose or stopping if something looks wrong. But a lot of this depends on the individual's constitution.

Q: Is it hard for a transgender person to find work?

Zhang Yushu: Almost everyone wonders what they're going to do with their future. Some kids come out to their parents at 15 or 16 and get thrown out — what do they do next? The good-looking ones can sell their bodies. The ones who aren't can't even do that.

For a long stretch those two things were directly linked, and even now some nonprofits work only with transgender sex workers. Personally I think even selling your body is part of a person's rights; it's a gray industry. What I do think is terrible is choosing that work because you have no other way to live. And that is still fairly common.

Lu Ping: The media's picture of transgender people is badly skewed — the assumption is that transgender people can't find work and most end up selling sex, so a lot of people worry that once they have gender reassignment surgery they'll end up the same way, and they feel lost about their future. The first transgender woman I met after starting college was a programmer in Beijing. That's when I knew transgender people aren't only sex workers; they're in every line of work.

6.

On June 18 this year, the World Health Organization released the latest edition of the International Classification of Diseases (ICD-11), which for the first time takes "Gender Incongruence" out of the mental illness section and lists it under sexual health instead. In the previous edition, ICD-10, the WHO had classified transgender people under "gender identity disorders."

Besides the ICD, the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the Chinese Classification and Diagnostic Criteria of Mental Disorders (CCMD) have also treated being transgender as an illness.

Progress like this has pushed discussion of transgender people and their rights into the open in one place after another around the world.

In China, a court in Guizhou Province ruled in January last year on the country's first case involving alleged workplace discrimination against a transgender person. The court found the plaintiff's dismissal unlawful, but found no evidence that transgender discrimination was behind it.

Speaking to the media about the compensation in the case, Huang Sha, the lawyer for the plaintiff, said: "This case also shows how low the cost of breaking the law is for companies. That's why employment discrimination is in such bad shape right now."

As Lu Ping and others see it, many of society's problems around transgender issues at this stage come down to basic knowledge that has never been spread widely enough. Wrong information deepens prejudice, and it also puts many people still exploring adolescence through real suffering.

*At the interviewees' request, all operator names in this article are pseudonyms.

Cover image: a still from Tomboy, via Douban Movie.