Accessing gender-affirming care

Trans people seeking gender-affirming care here have two options for medical transition — public or private. Each have differences in terms of cost, barriers to entry, and level of care. Here, we talk about the specialists involved, the type of support you feel you may need, and how you can navigate transition-related healthcare in a way that can be best for you.

Introduction

Singapore has two options for medical transition: public and private.

Public hospitals require a longer process that takes 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 with informed consent on the very first visit. Some private doctors only provide blood tests upon request and tend to charge a lot more. Consultations can cost upwards of $200-300 for a private doctor and $40-50 at a public hospital. Costs for tests and medication will be separate. For both the public and private routes, you will typically have to see two specialists—a psychiatrist and an endocrinologist—in order to access HRT.

What each specialist does

Psychiatrist

The psychiatrist will evaluate and diagnose you for gender dysphoria. They can also write memos requesting for accommodations (e.g. at schools and universities, and for exemptions from National Service). If you later wish to pursue gender-affirming surgeries, you may need a second assessment from them. Some psychiatrists can also help with explaining gender dysphoria and transitioning to parents or loved ones.

Endocrinologist

The endocrinologist will conduct blood tests and prescribe HRT. They provide for a consistent level of care, with regular blood tests to ensure that your HRT is administered in a safe and optimised manner.

As medical transition is a big step and can be very stressful, you may wish to consider seeing a trans-friendly counsellor to talk through this decision. This can help you get a better understanding of your identity, your reasons for wanting to go on HRT or for surgeries, the different options available to you, and the steps you plan to take. This helps you be clearer about what you are doing and why, be sure of your decision, and prepare yourself for the challenges you may face. 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.

The public healthcare route

Singapore citizens and PRs receive subsidised public healthcare when referred through a polyclinic.

If you are 21 and above and wish to transition under the public healthcare system, or want a formal evaluation and diagnosis for gender dysphoria through the public healthcare system, your first step will be to make an appointment with a polyclinic.

If you are between 18 and 21, the situation is little bit complicated: while hospitals and public health services may allow you to access some transition-related services, like voice therapy, HRT is not available in the public route. You can seek out general practitioners (GPs) in the private sector for access to HRT.

All private GPs however will require both parents to consent before HRT can be administered.

If you’re a private GP that is able to provide some form of HRT-related care for those between 18 and 21, we encourage you to email us so we can include you in our database.

If you’re 18-21 and require help with HRT access, you can also email us:

Email us

If you are not a Singapore Citizen or PR, you should instead make an appointment directly with a psychiatrist, where you would be considered a private patient. (This is more costly, but typically still cheaper than seeing a private psychiatrist.)

If you are below 21, your options are drastically more limited as HRT is generally not prescribed to those under 21 through the public healthcare system. Visit the page below for more information:

Gender-affirming care for minors

What to expect at the polyclinic

  • When you arrive, the receptionist may ask what you are seeing the GP for. If you are unwilling to out yourself to the receptionist, you can say that you’re there for depression or anxiety. Their main concern here is that you are not undergoing a medical emergency or are contagious (e.g. with COVID-19).
  • Inform the GP you are transgender and ask for a referral to a psychiatrist for gender dysphoria. A psychiatric evaluation is needed before HRT can be prescribed.
    • If you already have a diagnosis from a private psychiatrist OR have been on HRT for a considerable amount of time (e.g. more than 1-2 years), you can ask for a referral to an endocrinologist instead.
    • Indicate whether you have been on HRT, and for how long. This will help in determining how urgent an endocrinologist appointment will be.

    • OpenStreetMaps

    National University Health System

    Hospitals Alexandra Hospital National University Hospital Ng Teng Fong General Hospital Community hospitals Jurong Community Hospital Polyclinics Bukit Batok Polyclinic Bukit Panjang Polyclinic Choa Chu Kang Polyclinic Clementi Polyclinic Jurong Polyclinic Pioneer Polyclinic Queenstown Polyclinic

    National Healthcare Group

    Hospitals

    Institute of Mental Health Khoo Teck Puat Hospital Tan Tock Seng Hospital Woodlands Health Campus Community hospitals Woodlands Community Hospital Yishun Community Hospital Polyclinics Ang Mo Kio Polyclinic Geylang Polyclinic Hougang Polyclinic Kallang Polyclinic Toa Payoh Polyclinic Woodlands Polyclinic Yishun Polyclinic

    SingHealth

    Hospitals Changi General Hospital KK Women's and Children's Sengkang General Hospital Singapore General Hospital Community hospitals Bright Vision Community Hospital Outram Community Hospital Sengkang Community Hospital Polyclinics Bedok Polyclinic Bukit Merah Polyclinic Eunos Polyclinic Marine Parade Polyclinic Outram Polyclinic Pasir Ris Polyclinic Punggol Polyclinic Sengkang Polyclinic Tampines Polyclinic

  • Depending on the polyclinic and healthcare cluster, you should ask for a referral to the following hospitals:
    • Khoo Teck Puat Hospital (KTPH) if you live in the Central region, close to a National Healthcare Group polyclinic.
    • National University Hospital (NUH) or Ng Teng Fong General Hospital (NTFGH) if you live in the West, close to a National University Health System polyclinic.
    • Changi General Hospital (CGH) or Sengkang General Hospital (SKH) if you live in the East, close to a SingHealth polyclinic. (CGH requires that you see the endocrinologist for an initial evaluation, and may also require you to see a psychiatrist before HRT can be prescribed.)
    • You can check which cluster each polyclinic belongs to on the polyclinic appointment website.
  • The GP will then refer you to a psychiatrist or endocrinologist at that hospital. They will not be evaluating you for gender dysphoria, but may ask some short questions for their referral notes.
    • If you are not comfortable outing yourself to the polyclinic GP, you can ask for a general referral to a psychological medicine department citing depression or anxiety. However, do note that this may require more appointments and prolong the time before you can access HRT. Many trans people have gone through the polyclinic system, so most GPs are familiar with the process.

    • What to expect when seeing the psychiatrist

  • The psychiatrist will ask you some questions about your gender dysphoria and trans identity, as well as your plans for transition.
    • This may include questions about your life, when you realised you were transgender, and perhaps more stereotypical questions like what sort of toys you played with as a child. Depending on the psych, be prepared that some questions may be sexual in nature, though this is rarer these days.
  • It is possible to be approved for HRT after just one appointment, but it is common to have two or more sessions if you are young or the psychiatrist deems you unsure about the transition steps you wish to take. Additional appointments may also be needed if you have additional mental health or personal considerations that could impact your transition, e.g. severe depression or lack of support system.
  • When the evaluation is complete, the psychiatrist will give you a memo with a formal diagnosis of gender dysphoria based on their assessment, and refer you to an endocrinologist if you wish to pursue HRT.

    • What to expect when seeing the endocrinologist

  • Bring along your transition-related documentation such as psychiatrist memos, any overseas psychiatrist evaluations, private HRT prescriptions.
  • The endocrinologist will do a preliminary evaluation for related health risks from HRT, based on your personal and family medical histories.
    • The endocrinologist may ask you some questions relating to your gender dysphoria, and may refer you to their psychiatrist for a fuller evaluation if you have not been evaluated
  • The endocrinologist will send you for baseline blood tests to check your sex hormone levels and liver and kidney function. This is very important, as it will help determine if any future medical abnormalities are due to HRT or pre-existing medical conditions. Some hospitals additionally require bone density scans.
  • You can also ask for additional referrals to a speech therapist or a psychologist.
    • Any additional referrals should be registered for you 2-3 working days from the end of your first visit.

    • The private healthcare route

    Singapore has several private clinics that provide transgender healthcare services, including HRT. These cost significantly more than public hospitals, but have a shorter waiting time and provide a more discreet experience.

    General practitioners

    There are a small number of private GPs that prescribe HRT under informed consent.

    However, they are not psychiatrists and thus will not be able to diagnose you with gender dysphoria, which you will need if you plan to transfer to the public healthcare system or if you require accommodations with regards to schooling or National Service (NS).

    Private psychiatrists

    Private psychiatrists can evaluate you for gender dysphoria and write a memo with their diagnosis. You can use that diagnosis to see a private or public endocrinologist for HRT. Do note that private psychiatrists differ widely in their experience with trans issues, which can be a concern if you are unsure about transition being right for you.

    Private endocrinologists

    Private endocrinologists require a psychiatrist’s memo in order to prescribe HRT. They can also administer blood tests.

    You can email us for recommendations and more information.

    Email us

    Mixing public and private routes

    Some people may choose to begin HRT through the private route while waiting for their appointment at a public hospital. This can be a good option if you can afford it and would prefer not to wait, or want a more discreet experience.

    We do recommend shifting to a public route eventually as the difference in cost will be immense over the long run. The public route also ensures that you will have continuous care for the rest of your life, rather than risk an interruption if the private doctor suddenly quits or retires.

    With most hospitals, an assessment from a private psychiatrist can be used to obtain approval for HRT at a public hospital endocrinologist. (Changi General Hospital is the only exception, as they do their own internal assessments.)

    This document provides information on accessing gender-affirming care in Singapore, including options for medical transition through public and private healthcare routes, the role of psychiatrists and endocrinologists, and considerations for individuals seeking HRT.