People who have a gender identity that differs from the sex assigned at birth are known as transgender. While the term was something many avoided addressing, transgender people have become a part of the local society during the past few decades.

In 2006, the Supreme Court unanimously decided on gender correction and emphasized that transgender people have the right to pursue happiness while enjoying human dignity and value. Fifteen years have passed since the Supreme Court's decision. However, transgender people still regularly face discrimination as not much has changed regarding governmental policies or social perception toward them.

Notably, they faced a considerable void in receiving the proper medical care as no large hospitals had provided specialized care for such patients.

Against this backdrop, Professor Hwang Na-hyun of the Department of Plastic Surgery at Korea University Anam Hospital (KUAH) recently established Korea's first gender clinic.

"When I was in medical school, one of my best friends was a magazine editor, and I had a chance to meet with various transgender people while working with her," Professor Hwang said during an interview with Korea Biomedical Review. "The term transgender had no special meaning to me. However, after talking with them, I found out that they were human beings like you and me."

Hwang said that she could listen to stories of transgender people saving money to receive surgeries abroad during that time.

"I thought it was problematic that there were no doctors in Korea to perform such surgeries," she said. "This is why I decided to become a doctor that can help transgender people as I believed that transgender people should not be discriminated against from enjoying medical services."

Hwang stressed that one of the main reasons she chose plastic surgery was that she believed that was the department that could help them the most.

While the process was not easy, Professor Hwang managed to achieve her goal by opening a gender clinic at Korea University Anam Hospital in January.

"Many people think that university hospitals are conservative, but that is just stereotypical assumption," Hwang said. "When I told the hospital that I wanted to create a multidisciplinary team for transgender treatment, the hospital director and the head of our department gave me a lot of support."

While it wasn't easy to persuade everyone, no one objected to my idea, she added.

According to Professor Hwang, the reason her hospital named it “gender clinic instead of the transgender clinic” is because the center is not just for the transgender patients, but a variety of patients, including intersex patients or patients with congenitally ambiguous genitalia.

Multidisciplinary care is essential for running a gender clinic

Hwang stressed that when running a gender clinic, an interdisciplinary care system is essential because it is necessary at the beginning to decide which treatment is the most optimal for the patient.

"Our gender clinic consists of plastic surgery, obstetrics and gynecology, urology, endocrinology, colorectal and anal surgery, and psychiatry," Hwang said. "When a patient comes to the hospital, they first see our psychiatrist, and once they are diagnosed to have gender identity disorder, they can go on to receive hormonal therapy, and we try our best to provide them with the life that they want."

Afterwards, the patient can decide when and where they want surgery.

Hwang noted that not all patients go through the entire process. Not every patient wants breast surgery or facial plastic surgery. Also, some patients may not even want genital reconstruction.

"That's why our team makes it our top priority to choose the right treatment method for each patient," she said.

Korea is not yet fully ready to accept gender clinic

Asked if she believes Korea is prepared to accept the gender clinic, Hwang stressed that there still needs to be a lot of work in the area.

"In countries like Belgium, you can easily find transgender patients who have come to gender clinic hand in hand with their supportive parents," she said. "In Korea, transgender patients are shunned away from their families, and supports for transgender from the parents are hardly found."

In this ignorant and even discriminating environment, she added that Korea also lags far behind in the systemic structures of financial support, medical services, and legal frameworks for sexual minorities.

Notably, Hwang noted that the cost burden of the surgery is one of the main reasons why many Korean transgender patients choose to go abroad for these surgeries.

"However, management after surgery is crucial for patients' health as there can be cases of infections and need for revisional surgery," she said. "Understanding the exact conditions of patients is very difficult because often times foreign doctors are very reluctant to communicate with us."

Korea needs to revise legal frameworks for transgender

During the interview, Hwang also stressed that Korea needs to change its legal frameworks for transgender as many still have to undergo a complex and protracted legal process even after receiving surgery.

"Amending the sex designation in Korea is very complicated," she said. "The procedure is so vague and difficult that it depends solely on the subjective ruling of the judge."

Hwang stressed that in some cases, transgender patients might not succeed in amending their sex designation even after going through bottom surgery.

"One of the main criteria for sex designation change is having undergone surgery to create the vaginal canal," she said. "In foreign countries, transgender patients have a choice of cosmetic vaginal surgery where they may choose not to create a neo-vagina."

However, Korean transgender patients have no choice but to undergo the entire process of creating a neo-vagina even to get a chance of changing their sex designation, she added.

She noted that this is important. Unlike Europe or the U.S, Korea does not cover any transgender-related surgery with its national health insurance plan.

"If the surgery receives reimbursement, it can lower the economic burden of such patients, which, in turn, be of great relief to such patients," she said.

Hwang also strongly stressed that Korea needs to pass an anti-discrimination act.

"The act includes anti-discrimination for all, including the old, disabled, and sexual minorities," she said. "However, it is just so difficult to jump over the huddles of conservative mindsets that resist accepting sexual minorities."