Efficacy of gender-affirming therapy for transgender people in Pakistan

Dear Editor, According to the 2017 census of Pakistan, the transgender population has been estimated to be around 10,000. In contrast transgender activists speculate that the number may be closer to 300,000.1 Regardless of the number, the controversy surrounding transgenders, and their healthcare, has risen to the forefront of our society in the past several years. This was further fueled by the Transgender Rights Act of 2018 in Pakistan, which promised access to gender-affirming healthcare. The importance of providing gender-affirming healthcare to transgender individuals is underscored by the potential positive impact on their mental health, as demonstrated by studies conducted in the US. These studies have shown improved mental health outcomes, such as decreased suicidality and psychological distress, for transgender people who are undergoing, or have experienced, certain procedures.2, 3 These procedures, in the US, involve psychological help, gender-affirming hormones, surgery, and puberty blockers.4 Despite the 2018 bill’s promise to deliver trans-centred healthcare, a thorough investigation of the current literature reveals that no studies regarding the efficacy of these treatments have been conducted on the transgender population of Pakistan. While the validity of US-centred studies isn’t denied, Pakistan’s social and religious climate may demonstrate differing effects on their mental health. The quality of healthcare is further questioned after the proposed changes to the Transgender Persons Rights Act of 2018. These amendments would replace the term “transgender” with “intersex”,5 excluding transgender people with unambiguous genitalia and drastically reducing their access to healthcare. As the social climate heats up, trans people risk further discrimination. Therefore, it’s essential that researches be conducted to observe and test the impact of the current healthcare on transgender people, as it would highlight any gaps in the medical understanding of gender dysphoria, offer constructive criticism to help improve the state of healthcare, reduce healthcare discrimination, and aid the passing of more inclusive laws. We hope that studies will be undertaken on this issue to eventually create a healthier, safer space for transgender population.