Transgender healthcare is a critical aspect of medical care that encompasses the prevention, diagnosis, and treatment of physical and mental health conditions, including gender-affirming care. Around the world, transgender individuals face unique challenges in accessing healthcare due to societal prejudices and limited medical understanding of their needs. This article explores the global landscape of transgender healthcare, delves into the challenges faced by transgender individuals in Malaysia, and highlights the important project, "Practical Guidelines For Trans-Specific Primary Health Care In Malaysia," developed by SEED Malaysia and the Galen Centre for Health and Social Policy.

Transgender healthcare has evolved significantly over time. Historically, gender variance was often pathologized in medical literature, with diagnoses like "gender identity disorder" and "transsexualism." However, recent developments in the International Classification of Diseases (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) have redefined these terms and moved towards depathologizing gender variance. Moreover, gender-affirming care plays a crucial role in transgender healthcare, including hormone replacement therapy and gender-affirming surgery. While these options exist, not all transgender individuals desire the same medical interventions. The World Professional Association for Transgender Health (WPATH) provides standards of care, emphasizing informed consent and personalized treatment plans.

Access to healthcare varies worldwide, with some countries offering comprehensive transgender healthcare while others lag behind. Discrimination, violence, and societal stigmatization remain significant barriers for transgender individuals seeking medical care.

In Malaysia, transgender individuals, particularly the "mak nyah" community, face unique challenges in accessing healthcare. Gender transition often begins later in life within the supportive mak nyah community, leading to engagement in sex work to finance gender-affirming procedures. This involvement in illegal sex work subjects them to increased stigma and discrimination. Furthermore, healthcare utilization among mak nyah sex workers is often not normative. They resort to private and expensive healthcare, erratic care from government settings, or care that disguises their gender identity. Gender-affirming care and HIV/STI prevention are frequently neglected, and mental health concerns are rarely addressed. Finally, low perceived risk of HIV/STIs contributes to low screening rates among mak nyah sex workers. Self-medication with antibiotics to avoid testing is a concerning practice. Structural barriers, such as criminalization of gender identity, hinder access to adequate healthcare and perpetuate discrimination.

To overcome these issues, SEED Malaysia and the Galen Centre for Health and Social Policy developed the "Practical Guidelines For Trans-Specific Primary Health Care In Malaysia" project. In fact, its primary goal is to improve healthcare for transgender persons in Malaysia. The guidelines prioritize self-identification over professional opinion, aiming to reduce stigma in healthcare settings. These guidelines are a significant step towards creating a more inclusive and accessible healthcare environment for transgender individuals in Malaysia.

Access to healthcare for transgender individuals remains a global challenge, with varying levels of inclusivity and understanding across countries. In Malaysia, the mak nyah community faces particularly daunting obstacles in accessing transgender-specific healthcare. Criminalization and stigma persist as barriers to adequate care. To truly support transgender healthcare, it is essential to address not only medical needs but also the social and legal barriers that perpetuate discrimination and marginalization. The "Practical Guidelines For Trans-Specific Primary Health Care In Malaysia" project represents a crucial effort to address these disparities. By prioritizing self-identification and advocating for inclusive and culturally sensitive healthcare, this initiative can significantly improve the quality of life for transgender persons in Malaysia.