Dubbed torture, ID policies leave transgender people sterile

Across the world, scores of countries still require transgender people to submit to sterilizing surgeries before their genders are legally recognized

She was the only woman soldier working in the guard room, surrounded by men who harassed and frightened her after she said she was transgender. She tried to ignore them as they opened up their shirts and pretended to rape each other, while beckoning her to join them.

And then one day, as Lune Loh stood under the searing Singaporean sun, one of those men took his rifle and tried to shove it between her legs.

She was a woman. She was not supposed to be here, because Singapore’s compulsory, two-year military service is required only for 18-year-old men. But under Singapore law, she was still considered a man, because she had not undergone surgery that would render her sterile.

Across the world, scores of countries still require transgender people to submit to such surgeries before their genders are legally recognized, a practice international human rights bodies have condemned as torture. These policies have left untold numbers of transgender people with an agonizing choice between their fertility and their identity.

For those who opt against surgery, the policies’ consequences can be severe, limiting their prospects for jobs, housing, marriage and safe passage through the world. Since their identification documents list their genders as the opposite of how they present in public, they can easily be outed, leading to everything from bureaucratic hassles to life-threatening confrontations.

For some, the fear of being outed is so intense that they withdraw from the world. Loh, however, has taken the opposite approach, becoming an unusually visible transgender rights activist in Singapore, a rigidly controlled city-state that only announced it would decriminalize sex between men in August.

Now 25, Loh is still healing from the wounds of her military past. And she finds herself grappling with questions about her future, like whether any company will ever employ her, or whether she will ever be able to have a biological child.

And so, though speaking out carries risk, silence for Loh is not an option.

“People are not getting housing, people are not getting jobs … that’s basically what we’re fighting for,” she says. “We just want to help people survive another day, another month, another year.”

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At the heart of the debate over gender recognition laws is the importance of identity.

The legal documents that define our identity are crucial to navigating life and the world, from getting a bank loan to crossing a border. In much of the world, changing gender markers on identification documents remains impossible. Other countries allow such changes, but often with draconian prerequisites including sterilization, psychiatric interventions, and — for any married person — mandatory divorce.

“There’s a lot of requirements in most of these laws imposed on trans people which are all violating the basic human rights — the right to privacy, the right to bodily integrity, the right to non-discrimination, the right to identity,” says Julia Ehrt, executive director of the International Lesbian, Gay, Bisexual, Trans and Intersex Association, or ILGA World.

Surgery makes some transgender people feel more comfortable in their bodies, but others consider it medically unnecessary, invasive and painful or prohibitively expensive. Some people simply cannot have it for medical reasons.

Gender-confirmation surgery can involve a variety of procedures that alter a person’s sexual characteristics, some of which lead to permanent sterility. While the law in some countries explicitly spells out that sterilization must be an outcome for legal gender recognition, in most cases the ultimate intentions behind these policies are unclear and likely varied. But whether rendering transgender people sterile is the goal of these mandates, it’s generally the result.

In the U.S., 13 states and territories have a surgical requirement to update gender markers on birth certificates, and four require it for updating driver’s licenses, according to Olivia Hunt, policy director for the National Center for Transgender Equality. The states do not clarify what procedures they will accept.

Even after surgery, the process of obtaining a legal gender change can be convoluted and humiliating. In Australia, two states require two separate examinations of post-surgery genitalia by doctors, who must sign statutory declarations confirming “a surgical procedure involving the alteration of a person’s reproductive organs.” Any false statement by the doctor, the New South Wales state form warns, could result in two years’ imprisonment.

“We don’t even force sex offenders to be sterilized in this country, but you’re forcing transgender people just to get a birth certificate? Come on,” says Kirsti Miller, a New South Wales woman who underwent gender-confirmation surgery in 2006, and was forced to divorce her childhood sweetheart. New South Wales removed the divorce mandate in 2018.

In Singapore, the surgery requirement has affected even children, says Coen Teo, executive director of TransBefrienders, a non-profit supporting transgender youth.

Singaporeans under 21 must get parental consent to undergo gender-confirmation surgery, a landmine for transgender children reluctant to tell their conservative families about their transition. But if they don’t, they are required at many schools to use bathrooms and wear uniforms that match the gender marker on their national identity card, causing anguish.

“They don’t feel themselves in school, so they can’t concentrate in school, so a lot of them don’t do well. And I’m speaking from experience,” says Teo, a transgender man.

Most gender-confirmation procedures are not offered in Singapore, forcing several teens at TransBefrienders to travel overseas and spend possibly tens of thousands of dollars.

“They want to get back in school, they want to get back their life,” Teo says. “It’s a huge hurdle for them.”

In a statement to The Associated Press, the Ministry of Home Affairs said the information on Singaporeans’ national identity cards reflects a person’s “sex,” which the government determines based on the person’s “biological and physical attributes.” To change that marker requires “proof of surgery, and the complete alteration of one’s physical reproductive attributes,” the ministry said.

“This allows the government to implement policies and laws based on sex in a consistent manner,” the ministry said.

Human rights watchdogs have spent years demanding an end to policies like these. In a 2013 report, the United Nations Special Rapporteur on Torture urged governments to outlaw forced or coerced sterilization in all circumstances. The following year, seven U.N. agencies, including the World Health Organization, said gender recognition policies requiring sterilization “run counter to respect for bodily integrity, self-determination and human dignity.”

Many countries have been slow to respond. In 2019, Japan’s Supreme Court upheld as constitutional the country’s gender recognition law that requires surgical sterilization.

Some governments, however, have made changes. In 2012, Argentina became the first country to grant legal gender recognition based entirely on self-determination. In 2018, Sweden became the first country to financially compensate transgender people who were sterilized under its old policy.

Germany is considering similar compensation. Around 10,000 transgender Germans were sterilized under the country’s former policy, according to advocacy group Bundesverband Trans(asterisk).

Cathrin Ramelow, a 58-year-old German transgender woman, is fighting for compensation and an apology from the government. In 2000, she underwent surgical sterilization, welcoming the chance to end her double life. But afterwards, she says, she agonized over what she had lost.

“You know there’s something wrong with you and you can’t have children anymore,” she says. “I cried some days.”

Years later, Loh would make the opposite choice. But she found that it, too, came with a steep cost.

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Tucked against the wall of a spare room in Loh’s apartment is the camouflage backpack she carried during her two years of enforced military service. One recent afternoon, she plunges a slender arm inside it and pulls out her old helmet, staring at it briefly before shoving it away.

They are artifacts of a time she likens to torture. She remains vanishingly thin from the eating disorder she developed during her service, an attempt to counter the masculinization of her body from the intense physical drills.

Loh is a poet with a wide grin, brainy and sensitive, eager to chat about philosophy, politics, art and music. But when she talks about her army days, her easy laugh turns nervous and her face goes dark.

She was raised as a boy by a protective mother and a conservative, stern father she grew to fear. Though he socialized Loh to be masculine, she knew early on that her body did not match who she was. Her first realization — or “flash point” — that something was off came one night at age 8, when she caught her distorted reflection in a window and suddenly imagined herself with long hair.

More flashpoints would follow until at 17, she read an article about transgender people coming out late in life. That was, she says, the moment her “egg cracked”: How much longer will you wait, she asked herself, before you live the life you want?

She would wait one more year, until after her father had left the family. Her mother, Stella Wong, would embrace Buddhism, and ultimately Loh’s identity.

“Everything is impermanent, whether you are male or female,” says Wong, whose normally cheerful manner morphs into rage when strangers stare at her daughter. “In Buddhism, gender is nothing.”

Yet by the time Loh began transitioning, she had been conscripted under Singapore’s National Service requirement.

The Ministry of Defense’s public position on transgender people — reiterated in a statement to the AP — is simply: “Those who are legally declared female will not be required to serve.”

There are backdoor ways to sometimes get an exemption, but they are unofficial and often unknown, as with Loh. And she did not want to undergo sterilizing surgery because her conservative upbringing left her wanting her own biological children — or at least the potential for them.

“Does the government not want trans people to have children of their own?” she asks.

And so, riddled with dread, she started her service, steeling herself as the silky black hair she had begun growing out was summarily shaved off.

The other soldiers made sexual comments and asked what color underwear she was wearing. One man repeatedly asked for sex in messages that left her so frightened, he began haunting her nightmares.

She despised combat training, having to roll around in the jungle with the men. She cried afterwards in her mother’s arms. Panic attacks set in. She became suicidal.

Poetry was a lifeline. In between exercises, she lay in her bunk, typing poems into her phone. After her shifts, she put on makeup and a wig and went to open mic nights around the city that drew members of the LGBTQ community.

One poem she wrote then, “Moonface,” detailed her exhaustion over her warring identities, “that whiplash whenever you take off the wig.”

“I just felt like the faces of the moon. Sometimes you’re showing half your face,” she says.

She survived her service and entered university, where she fully socially transitioned. But her legal status as male continued to cause problems, forcing her to live, uncomfortably, on the male corridor of her dormitory. She was arrested for participating in a protest for transgender rights without a permit outside the Ministry of Education building, and given a year’s probation.

Meanwhile, Loh found herself fretting about her future in ways most early-20-somethings don’t have to. She wanted to start hormone replacement therapy, but worried it would permanently affect her fertility. And she could not freeze her sperm for non-medical reasons because “social freezing” is not allowed in Singapore.

Loh researched fertility clinics overseas, but became discouraged by the cost and the complexities of accessing her gametes, or reproductive cells, from Singapore. She began to rage at the limitations placed upon her life.

“I have no avenue to fall back on,” Loh says. “I have to go to another country to possibly pay more to preserve my gametes. Why do I have to go through all that? Why do I have to risk my own body?”

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Loh had to weigh more than the risk to her fertility. She had to weigh the risk a mismatched ID card could pose to her life.

In 2019, Loh and her family travelled to neighboring Malaysia for a day of shopping. Loh handed the Malaysian immigration officer her passport, which lists her gender as male.

The officer stared at Loh, and when she spoke, her voice was steely. “You should go cut your hair,” she snapped.

The words sent a chill through Loh. She knew that in Malaysia, simply being transgender is considered a crime. She had read stories about transgender people there being mobbed and killed.

She hurried across the border. Now, she makes sure to sweep her long hair back at checkpoints.

“I’m terrified of traveling now partially because of that,” she says. “I still think about it to this day.”

Given the prevalence of violence against transgender people, mismatched IDs can present a grave danger while traveling, says Ehrt of ILGA World.

“When you’re in a position of vulnerability such as you are at a checkpoint, or you need to cross a border, then of course it’s aggravated when your ID doesn’t match,” Ehrt says. “If a trans person of color has a nonmatching ID card and wants to cross a border, that is a catastrophe.”

A 2015 survey of nearly 28,000 transgender people in the U.S. found that almost a third of those who presented a mismatched ID had endured negative experiences, including harassment and assault, according to the National Center for Transgender Equality, which conducted the study.

For a few, the fear of discrimination is so intense that they are reluctant to leave not only their country but even their house.

Jojo, a 32-year-old transgender woman, has spent years largely confined to her parents’ Singapore home. She spoke on condition that her full name not be used to avoid harassment.

“The thought of being in situations where I need to present the identity card and having confrontations terrifies me,” she said by e-mail.

She steps outside only occasionally for short walks, and survives on the support of her financially strapped parents. She has no current plans to undergo surgery, and thus no prospect of obtaining an identity card that matches how she looks. She hopes one day the surgery requirement will be replaced with something less invasive, such as requiring a person to live for two years in their preferred gender.

Loh doesn’t see that happening any time soon.

“I feel like the earth will cook us alive faster than we can get legal gender recognition,” Loh says. “It’s an uphill battle and I’m already exhausted.”

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For those whose identities are denied by the state, the result can be financial ruin.

This is particularly true in Singapore, where government benefits are designed around heterosexual families, especially when it comes to finding a home. Eighty percent of Singaporeans live in government-subsidized housing. The catch: If you’re under 35, you can only get that housing if you’re married. And same-sex marriage remains banned.

“The reality is that the gender marker in Singapore is something that gives you access to different things and different resources,” says Loh. “Every single policy that benefits people is tied to getting a heterosexual arrangement.”

At 25, Mick Yang wonders how much longer he will have to wait before he can afford to move out of his parents’ home. As a transgender man who opted against sterilizing surgery, the state still considers him a woman. So he cannot get married and thus cannot access subsidized housing for at least another decade.

The policy also means his chances of having a biological child are slim, as only married women are allowed to use frozen eggs to conceive.

“I don’t like the idea of not even having that option,” says Yang. “As I get older and more of my peers move into that life stage, then I think it gets more aggravating and agonizing to feel that lack of freedom and rights.”

Conversations with colleagues excited about their new subsidized apartments leave him feeling gutted.

“I’ve contributed just as much to this place and care as much and yet I cannot etch out a home for myself or any conceivable future family,” he says.

Having a mismatched ID can also limit transgender people’s employment prospects.

Although Teo of TransBefrienders passed the interview for an aviation training role, he was rejected after he produced his ID, which outed him as transgender. His would-be employers, he says, told him the conservative Ministry of Education might reject his application to be a trainer because his appearance clashes with his gender marker.

It all becomes a frustrating loop: Because finding work is difficult, transgender people tend to be less affluent, which means many can’t afford unsubsidized housing, let alone the surgery for a legal gender change.

Among the many fears Loh has about her future, finding a job tops the list. “Will they reject me because I’m trans?” she wonders.

Loh’s mother worries about how her daughter will navigate a future in which so many options have already been ripped away.

“But I have no choice,” Wong says. “Because in Singapore, we abide by the rules. Me too.”

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Loh finds solace in the rare spots on the island that feel cocooned from the rules. One recent evening, that spot is a softly lit loft where poets have gathered for an open mic night.

Loh laughs and embraces her friends, sliding past a bar lined with more books than bottles of booze. The crowd is a mix of genders, races and sexual orientations.

Here, there is no judgement, no stares, no ID cards required. Loh revels in the freedom to be herself. “This is literally my space,” she says.

She sifts through her phone, debating which poem to perform, ultimately selecting one about her hard-won identity as a woman.

Soon it’s her turn at the microphone. The audience listens, rapt, snapping their fingers in support as she lays bare her pain and perseverance.

The applause washes over her. She smiles as she is seen, by her peers if not her government, for exactly who she is: A woman.