Transition in Singapore

Contents

Reader advice (2004)

Military service (2007)

See also

Name change in Singapore

Leona Lo

Written by a reader in December 2004.

Why did I write this?

I wrote this because there was very little or no information about transition in Singapore. The resources are nearly non-existent or so hidden in secrecy nobody knows what’s going on.

I have spent thousands of dollars on medical fees, visiting doctors who have given bad advice, given wrong information, and wrong medication. I could have chosen to bring the doctors to court for mal-practice, I decided not to because: (a) the way in which the press reports about transsexuals (hint: very badly) (b) I decided to go deep stealth (hint: nobody knows that I am a transsexual) and (c) the way in which other “fellow” Singaporean treat others.

Friends and people in my profession destroy my trust. I don’t trust anyone anymore. My relationships are strictly business and nothing personal. If you want to do business with me, you earn my trust first before I do business with you. If you do stupid things, like name-calling, making fun of people, I will never ever talk you to ever again. All actions and emotions are pre-calculated and pre-measured to ensure I do not expose any weaknesses that anyone can take advantage of.

What should I do first?

You need to find four people to help you. The first is a psychiatrist and the second is an endocrinologist. The third is a doctor who does electrolysis or hair removal and the forth is a surgeon.

The order is:
a) First find a psychiatrist to get a letter to give to the endocrinologist.
b) Find an endocrinologist who can issue hormones to you.
b) After you do that, follow the instructions on the tsroadmap.com website.
c) Find a doctor who does hair removal.
d) Eventually, find a surgeon.

What do I need a psychiatrist for?

You need to find one, so that he / she sends a referral letter to the endocrinologist to give you hormones.

You need to see the psychiatrist first before you see the endocrinologist; otherwise, if you go to the endocrinologist, he will refer you to see the psychiatrist before he can issue any hormones.

On the other hand, you can ask the endocrinologist if that psychiatrist has referred any patients to him. If the endocrinologist has never heard of him or her, you can consider finding another psychiatrist instead.

The idea is to conserve money and spend it wisely. Visiting a doctor cost money. They demand money for any consultation.

Where do I find a psychiatrist and endocrinologist?

You find one on the Ministry of Health Website.

http://www.moh.gov.sg/corp/eservices/profsearch.do
Search for the word ‘psychiatrist’ and ‘endocrinologist’ and get a list of doctors.
[See below for more information]

I have been to “this” psychiatrist and I have been with several sessions and I’m not getting anywhere.

The reason is because “that” psychiatrist has not counseled any transsexual, or is so biased towards them, he / she intentionally leads them to the wrong direction.

I have heard of the Gender Identity Clinic at NUH. Is that any good?

Obtaining data from other people, they refer you to a private psychiatrist – Dr Tsoi Wing Foo. (This statement was verified verbally by Dr Tsoi Wing Foo.)

The previous history is that NUH closed down that clinic and re-opened it five years later. In the mean-time, [to be done].

Can you recommend a psychiatrist?

Searching on the MOH website for the name ‘TSOI’ you get the answer:

Name Dr Tsoi Wing Foo
Registered on 15/07/1960
Registered Specialty Psychiatry
Practice Place Tsoi Clinic
Practice Address Blk/House 19 Tanglin Road
#06-02 Tanglin Shopping Centre
Singapore 247909
Tel 67345191

Other information:
a) S$100 for the first consultation
b) S$60 for the second and subsequent consultation.
c) You need to call him up and ask for an appointment before you go down there.
d) You need to pay by cash, he don’t accept NETS, Visa, Master Card or Amex.

The reason why you should go this person is because:
a) He has counseled over 1,000 TS-s.
b) His rates are inexpensive.
c) He gives correct advice and correct information.

On your first visit (or subsequent visits), you should get a referral letter to give to the endocrinologist to issue to you hormones.

The psychiatrist gave some sleeping pills or gave some anti-depression medication instead!

Sleeping Pills is a controlled medication. Law prohibits issuing sleeping pills without proper supervision or consent. You may want to file a complaint to the SMC (Singapore Medical Council) if you were issued sleeping pills not related to sleeping problems.
Some doctors have been struck-off the registrar by issuing sleeping pills without good reason. (Meaning, they cannot continue their practice and have to give up their medical profession.)

The psychiatrist is pushing religion and family matters instead!

Download the PDF guide “Ethical Code and Ethical Guidelines” and read it first.

http://www.smc.gov.sg/html/EthicalCodeGuide.html

In particular:
4.1.7.1 Non discrimination of patients
A doctor is obliged to provide access to medical care and treat patients without prejudice of race, religion, creed, social standing, disability or socioeconomic status. A doctor shall not allow his personal beliefs to influence his management of his patients. Where a doctor feels unable to continue his care for a patient due to such beliefs, the patient should be referred to another doctor who is able and willing to care for the patient. An example of such a situation is a request for an abortion.

Where do I file a complaint about a certain doctor?

The link is below:

http://www.smc.gov.sg/html/ComplaintDisciplinary.html

Can you recommend an endocrinologist?

There are four places in Singapore. Take your pick:

What happened to SS. Ratnam?

He passed away a few years ago

What do I do next after I visit the psychiatrist and endocrinologist?

Follow the instructions on the tsroadmap.com website.
(You should have chosen a therapist by now).

After doing the above:
- You need to accept yourself for who you are. You need to make that a final decision. that a final decision.
- Once you done that, you tell your parents and friends about this.

Where do I go for hair removal?

You need to go for “permanent hair removal” not “temporary hair removal”. That means you have to go to a medical establishment. There are plenty of Beauty Parlors and Beauticians who do “waxing” for you. (See Andrea’s hair facts website for more info.)
The reason why you need to go to a medical establishment (i.e., clinic) is because Laser, IPL Electrolysis require a medical license in order to operate these equipment. Beauty Parlors don’t have a license.
There is a difference – if you closely check the advertisements by Beauty Parlors they advocate “waxing” (the more famous being the Brazilian wax), “photo epilators”, “transdermal hair removal”.
The other difference is the amount of money required for hair removal. Beauty Parlors require “around ten thousand” while clinics require “a few thousand”.
The cost for the twenty thousand break-down from two beauty parlors were:
a) Hair removal on chest – S$5,000 (around 12 treatments, 1 month each).
b) Hair removal on leg – S$2,000 (around 12 treatments, 1 month each).
Therefore, check around the Yellow Pages under “doctors” or “hair removal”.

The Press, “Medical Confidentiality” and “Social Services Confidentiality”

Observing for long periods of time, the most interesting thing is how the press (Straits Times and New Paper) handle medical information about transsexuals -

The following were observed:
a) Tell the press it’s none-of-your-business and the press has no right to know about any medical information or your gender identify status. In-depth reporting about transsexuals has been usually to “degrade” and “humiliate” transsexuals.
Favorite newspaper articles by the press are:
• “Transsexual prostitution” (how many transsexual prostitutes are there vs. the female (or male) prostitutes in a country of 5 million people?),
• ‘Alternative lifestyle’ by transsexuals (how many transsexuals live an alternative lifestyle vs. non-transsexuals who live an alternate lifestyle?)
• The usual hate mongering by various Christian groups.

b) The press has no right to know about your medical history, or your medical past. You should avoid giving any information about your past. Any information about this is just to make the story more sensational and biased towards showing transsexuals in a bad light. It usually becomes the “cover story”.

c) If the source of information given to the press came from doctor about you, you have the right to file a complaint against that doctor, citing medical confidentiality.

d) Social services and churches are not bound by any patient confidentially clauses, and “liberally give” information to the press.

That means, if you visited XYZ church previously and left, the pastor (or priest) at XYZ church would very happy to entertain the press and provide information (against you) instead of citing confidentiality.

There are no confidentiality clauses at religious places. If you go for help with religious places, bear in mind that they are more interested in donations than to help you.

If you visited a social worker or counselor and left, that person would be very happy to entertain the press and provide information (against you) instead of citing confidentiality.

To add injury to the insult, they mention words like “prostitution” (like as if all of us are prostitutes), “AIDS, HIV or STD (Sexually Transmitted Diseases) (like as if all of us like to have sex all the time), “alternate lifestyle” (like as if all of us like to have fun and party all the time).

For the benefit of doubt, read the newspaper daily. Read articles where some people have problems and require social services. Check what the reply was from the social worker or social service. What right does the social service have to provide information about the person to the press? It should be none of your business to know.
e) In order to write a reply to any

Should I setup a website?

Some practical advice are:
- Avoid setting-up a website to say you are transsexual
- The problem with the Internet is the long history of facts and archived information long after the fact or details were posted on the Internet. You don’t want to be haunted six, seven or eight years after you took down your transsexual website.

What articles has Dr. Tsoi written?

Developmental profile of 200 male and 100 female transsexuals in Singapore.
Arch Sex Behav 1990 Dec;19(6):595-605 (ISSN: 0004-0002)
Tsoi WF
Department of Psychological Medicine, National University of Singapore.
Two hundred male and 100 female transsexuals compared with 100 male and 80 female heterosexuals were studied in Singapore. Transsexuals started their psychosexual development earlier than controls. Transsexual feelings started in childhood. Male transsexuals went through a homosexual phase followed by a transvestite phase, before they became transsexual. Female transsexuals did not go through distinct phases. Cross-dressing was one of the early signs of transsexualism and started earlier in females. None of the transsexuals were married, in contrast to reports showing that up to 50% of Caucasian transsexuals had been married. Cultural differences may explain the contrasts between Singapore transsexuals and patients from Western countries.
Indexing Check Tags: Female; Human; Male
Language: English
MEDLINE Indexing Date: 199105
Publication Type: Owner: NLM
Publication Type: Journal Article
PreMedline Identifier: 0002082863
Journal Code: IM

Male and female transsexuals: a comparison
Singapore Med J 1992 Apr;33(2):182-5 (ISSN: 0037-5675)
Tsoi WF
Department of Psychological Medicine, National University Hospital, Singapore.
The aim of this study is to describe and compare the characteristics of 320 male and 130 female transsexuals in Singapore. The subjects were given a semistructured psychiatric interview. The results showed that the males were slightly younger, had less education and held lower level jobs. Their occupational preferences were reversed. The male transsexuals started petting, sexual intercourse and having partners about one to two years earlier, but they cross-dressed four to seven years later. Both males and females were homosexually orientated. Other studies showed that late maternal age was associated with homosexuality, but not with transsexualism. These studies also confirmed that transsexualism had its onset in early childhood, and that cross-dressing was an early feature. The Singapore 'transsexuals went through a "homosexual" and a "transvestite" phase before they became a transsexual. Western transsexuals exhibited both homosexual and heterosexual behaviour, and some were married to the opposite sex partners. Male prostitution was reported in many studies.

Sex reassignment surgery in the male transsexual.
Br J Hosp Med 1987 Sep;38(3):204-8, 212-3 (ISSN: 0007-1064)
Ratnam SS; Ilancheran A
Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
Failure of psychotherapy alone in the treatment of male transsexuals led to the development of modern sex reassignment surgery. Here we describe our technique, its indications, complications and outcome.
Indexing Check Tags: Human; Male
Language: English
MEDLINE Indexing Date: 198712
Publication Type: Owner: NLM
Publication Type: Journal Article
PreMedline Identifier: 0003676546
Journal Code: IM

Follow-up study of transsexuals after sex-reassignment surgery.
Singapore Med J 1993 Dec;34(6):515-7 (ISSN: 0037-5675)
Tsoi WF
Department of Psychological Medicine, National University Hospital, Singapore.
INTRODUCTION: This is a follow-up study of 45 male and 36 female sex reassigned transsexuals. METHOD: The subjects were interviewed before and 1 to 8 years following sex reassignment surgery. RESULTS: When first seen the males (mean age 23.8 years) were slightly younger than females (mean age 24.9 years). The males had less education and held lower level jobs. They started their sexual life about 1-2 years earlier, but they cross-dressed 4-7 years later than the females. The follow-up results showed that 35% were married and all of them had no problems adjusting to their new life. The overall results were 56% very good and 44% good. There is no pre-operative variables that can predict good adjustments for female transsexuals. For male transsexuals, earlier age of transsexual manifestation was related to good post-operative adjustments. DISCUSSION: The females were less satisfied with the surgery, but they adjusted well as the males. The results were comparable with those from previous studies.
Indexing Check Tags: Female; Human; Male
Language: English
MEDLINE Indexing Date: 199405
Publication Type: Owner: NLM
Publication Type: Journal Article
PreMedline Identifier: 0008153713
Journal Code: IM

Parental influence in transsexualism.
Singapore Med J 1990 Oct;31(5):443-6 (ISSN: 0037-5675)
Tsoi WF
Department of Psychological Medicine, National University of Singapore.
This is a study of parental influence in a group of Chinese male and female transsexuals compared with a group of male and female heterosexual controls. There was no difference in the parental ages of the transsexuals and controls at time of their birth. The fathers of the male transsexuals and the mothers of female transsexuals were less involved in their upbringing. Using a bonding instrument, the fathers of male transsexuals were found to be less caring, and mothers of female transsexuals were less overprotective than the fathers and mothers of the controls. Studies on parental involvement in male transsexuals showed a weak father figure and an overinvolvement with the mother, and in female transsexuals, an unsatisfactory mother-daughter relationship. Abnormal parental-child relationship, postulated as an important aetiological factor in transsexualism, needs to be further confirmed.
Indexing Check Tags: Female; Human; Male
Language: English
MEDLINE Indexing Date: 199101
Publication Type: Owner: NLM
Publication Type: Journal Article
PreMedline Identifier: 0002259939
Journal Code: IM

The prevalence of transsexualism in Singapore.
Acta Psychiatr Scand 1988 Oct;78(4):501-4 (ISSN: 0001-690X)
Tsoi WF
Department of Psychological Medicine, National University of Singapore.
The prevalence of transsexualism in Singapore was estimated by counting all the patients who sought sex-reassignment surgery and were subsequently diagnosed as transsexuals by psychiatrists. Up to 1986, there were a total of 458 Singapore-born transsexuals, of which 343 were males and 115 were females. This was a prevalence of 35.2 per 100,000 population age 15 and above (or 1/2900) for male transsexualism, and 12.0 per 100,000 (or 1/8300) for female transsexualism. The sex ratio was about 3 males to 1 female. The main reason for the high prevalence was the availability of sex-reassignment surgery.
Indexing Check Tags: Female; Human; Male
Language: English
MEDLINE Indexing Date: 198903
Publication Type: Owner: NLM
Publication Type: Journal Article
PreMedline Identifier: 0003265846
Journal Code: IM

Military service

(from a reader in April 2007)

Well, I just finished a nice long stretch of dealing with the military. In Singapore, any citizen identified as male at birth is required to perform 2 years of military service, and then will be put in the reserve hence till 40 or so (varies by rank). Unfortunately, since military service is compulsory, there will invariably be cowards, objectors or anyone else otherwise unwilling to waste that time who will try ways and means to worm their way out of service. This naturally makes it harder for legit TS to avoid this otherwise unnecessary (and uncompensated!) waste of time.
 
I did my time. It's basically a waste as there's no way for me to say I did a good job (and I did!) without revealing that I'm TS. Anyway, it's not gona boost my employability much as every identified-male does it and being seen as doing a good job doesn't really put you much above the rest.
 
Basically, even if you declare that you're TS (or gay, which is most of the time entirely different), you'll still have to do time. The only way out is to undergo SRS or be otherwise female in some shape or form. Perhaps you're intersexed, for instance.
 
But something TS should note is that if you are pending SRS (rare but possible before 18), it's possible to file an appeal with the Ministry of Defense (Mindef) to postpone enlistment for a reasonable period of time (exact period unknown) until such time that your SRS can be completed. Actually, I'd like to see what would happen if a pre-18 TS were to declare this to Mindef and appeal for deferment till her transition is completed. The locals just aren't terribly interested in trying new things. Of course, it doesn't hurt to declare it after your 2 years.
 
I personally declared after I did my time, and got downgraded in readiness status about as low as guys can get without being removed from service altogether (PES A is highest. You're totally fit in every way. I got PES E9L9. If you're PES status F, you're basically female, crippled or otherwise totally unfit for service. If your employers find this out, they'd automatically assume something's majorly wrong with you. Will affect employability) I checked, though, and I've been removed from my old military unit, so being summoned as a reserve is highly unlikely. Over here, I think it takes a psych letter to vouch for you. Failing which, they probably would put you through their own military psychologists and some psych profiling.
 
If you're a pre-enlistee TS, declaring at the enlistment medical checkup has its pros and cons. I didn't, and am unsure if my life would indeed be better had I actually done so. I saw a TS in one of my units and she was outed...possibly because confidentiality has to be broken in order to order the men NOT to abuse the said soldier. Pretty counter-intuitive. But on the plus side, they probably wouldn't put you on combat duty 'coz you're a security risk (raping the men, maybe? =p)
 
There are some ways of getting out of service at the enlistment medical checkup, but I'm unsure if they should be revealed, since it could be abused by those just trying to escape service and this makes life a lot harder for the real TS. I mean, some guys will do anything to escape being assigned to a combat unit because the training's tougher and they gota stay in camp through the week (we don't go to war with these guys. Not yet anyway) I don't know if they'd use the TS excuse to worm their way out of the combat side, too. Anyway, I hope this info will come in useful in some way.