On June 16 China's Ministry of Health unveiled a set of regulations entitled "Technical Management Standards of Transsexual Operations" in order to solicit feedback from the public.

The move indicates that the regulatory gap in the gender-alteration business will soon be plugged, the Beijing News reported.

According to this version of the regulations, hospitals at the highest technical level with more than 10 years' experience in the field of plastic surgery will be qualified to carry out transsexual operations. Moreover, every such hospital shall set up a technical and ethics committee consisting of experts in physiology, law, and ethics. The committee is responsible for analyzing potential operations and giving the go-ahead.

Qualified doctors must hold professional licenses and have more than 10 years' experience in plastic surgery, including more than five years in transsexual operations. Additionally, they should have independently completed a minimum of 10 cases of sexual organ reconstruction before performing a full-scale operation.

Dr. Gu Tingmin with the PLA Military General Hospital of Beijing said that there are a few dozen hospitals in China that are capable of performing transsexual operations. Such an operation usually costs 100,000 to 150,000 yuan (US$14,632 to US$21,947). Previously, without standards, some technically inadequate hospitals were looking to penetrate the market, resulting in disputes, Dr. Gu said, adding "But now the new regulations will disqualify these institutions."

As for the sex-change candidates, the regulation stipulates that they shall be single and over 20 years old. In addition, they should not have any criminal record. They must also make the necessary arrangements with local public security authorities to change their gender in their ID after the operation is completed.

They are also required to prove a consistent desire for a sex change, to have lived full-time for at least five consecutive years in the new gender role, and to engage in psychological therapy for at least one year.

Qiu Renzong, bioethicist at the Chinese Academy of Social Sciences, said he believes this last requirement is not appropriate. He also disagrees with the clause that the candidate has to live for at least five consecutive years full-time in the new gender role.

"Chinese Transsexuals who might consider a sex change remain largely concealed in mainstream society. It's hard for them to live and work openly in the gender role they want," he explained.

"As long as a person meets the primary physical and psychological requirements, she or he should be granted permission to have the surgery," he said. "The police should change the sex of the patient on the identity card accordingly."

He did, however, acknowledge the validity of the requirement for no criminal record, citing public security.

He Qinglian, a veteran doctor of plastic surgery including sex-change operations with the Shanghai 411 Hospital, said all stakeholders, including the hospital and the prospective candidates for the operation, should be highly cautious about this surgery.

The operation is more than a medical procedure due to its huge social and legal consequences, He noted.

"The surgery should be the last resort for people who are struggling with their gender," he said.

Doctors should make it clear to those seeking sex-change surgery that the option of living in the original role is always an option.

(China.org.cn, China Daily June 17, 2009)