Part I Experiences of being lesbian, gay, bisexual, transgender and intersex in the Asia Pacific 3.6. ACCESS TO GENDER-AFFIRMING HEALTH SERVICES 3.6.1. Human rights standards The right to the highest attainable standard of health requires that health services are available, accessible, acceptable and of quality. This means that all people, including transgender people, are entitled to be treated with respect and dignity, free from discrimination, when accessing health services.226 The need for gender-affirming health services has been specifically addressed by international and regional human rights and health professional bodies. However, transgender people worldwide experience substantial health disparities and barriers in accessing appropriate health services.227 In the Asia Pacific region, these gaps have been documented in a series of reports commissioned by UN agencies.228 3.6.2. Terminology The term ‘gender-affirming health services’ covers the full range of procedures a transgender person may require in order to medically transition. It is much broader than commonly known terms such as ‘sex reassignment surgery’ or ‘sex change operation’. Sex reassignment surgery describes the surgeries that transgender people undergo to change their genitals to better match their gender identity. This only focuses on one potential medical intervention that a minority of transgender people in this region are able to access. ‘Gender-affirming health services’ is a broader term that recognises that there are many health interventions that can affirm a transgender person’s identity. These include, for example, counselling and peer support, hormone therapy, hair removal, chest or breast reconstruction surgeries and surgeries to modify other parts of the body, including genitals. One of the unfortunate impacts of the term ‘sex change operation’ is that it takes the focus away from the many other practical ways that mainstream health services can meet better the needs of transgender people. First and foremost, this is by listening to transgender people and understanding their health needs and then following ethical and professional standards to provide them with access to the highest attainable standard of health. 3.6.3. Medically necessary treatment International and national health professional bodies working with transgender people have consistently recognised that gender-affirming health interventions are medically necessary for many transgender people.229 The immediate priorities for many transgender people are to have medical interventions that change their outward appearance so they can get on with their lives. This typically involves reversing the masculinising or feminising impacts of naturally occurring hormones in their body by blocking these hormones and replacing them with cross-sex hormone therapy. However, hormones alone will not remove a transgender woman’s facial or body hair or change her voice. 226 Committee on Economic, Social and Cultural Rights, General Comment No. 14: The right to the highest attainable standard of health (Article 12 of the Covenant), 2000, E/C.12/2000/4; Committee on the Rights of the Child, General Comment No. 15: The rights of the child to the highest attainable standard of health, 2013, CRC/C/GC/15; Committee on Economic, Social and Cultural Rights, General Comment No. 20: Non-discrimination in economic, social and cultural rights (art. 2, para. 2, of the ICESCR), 2009, E/C.12/GC/20; Committee on the Elimination of Discrimination against Women, General Recommendation 28: Core obligations of States Parties under Article 2 of the CEDAW, 2010, CEDAW/C/20107477GC.2. 227 World Health Organisation, Sexual health, human rights and the law, 2015. 228 For example, S. Winter, 2012; World Health Organization, Regional Assessment of HIV, STI and other Health Needs of Transgender People in Asia and the Pacific, 2013; Health Policy Project et al, 2015. 229 E. Coleman, W. Bockting, M. Botzer, P. Cohen-Kettenis, G. DeCuypere, J. Feldman and K. Zucker, Standards of care for the health of transsexual, transgender, and gender nonconforming people, 2011; World Professional Association for Transgender Health, WPATH clarification on medical necessity of treatment, sex reassignment, and insurance coverage in the USA, 2008. Chapter 3: Being transgender in Asia and the Pacific | 61