By Hanan Mastenbroek
Imagine sitting down in a doctor’s waiting room. Other’s names get called, one by one, but yours never does. It’s not because there’s no doctor, but because the system was never built with your name in mind. This is what accessing care feels like for many transgender and gender diverse (TGD) people. While they’ve expressed their needs, the healthcare and legal systems are slow to provide them.
A 2026 study published in the South African Medical Journal provides an unflinching and clear-eyed look into the lives of TGD people in South Africa. More specifically, into the process of accessing vital gender-affirming care. TGD individuals are disproportionately subjected to bigotry, prejudice and violence, with this study exploring how that discrimination manifests through lack of access to gender-affirming care. Gender-affirming care is a collection of medical, behavioural, social and psychological interventions provided to affirm a person’s gender identity.
In this cross-sectional study, 150 TGD individuals were surveyed using a structured questionnaire. The questions focused on the respondents’ access as well as need for gender-affirming care.
Figure 1: Percentage of participants identifying transgender and as gender diverse. (AMAB = assigned male at birth; AFAB = assigned female at birth).
The study also captured the sociodemographic profile of the participants. TGD communities have been found to be among the most vulnerable groups in many societies, with this study’s results echoing that pattern. This was reflected in high rates of unemployment and reported housing insecurity.
Hormone therapy: need vs access
With the sociodemographic profile established, the study turned to access to care. For hormone treatment specifically, the gaps are stark. Looking at AMAB participants, many respondents wanted access to oestrogen, progesterone and/or testosterone blockers, with only a small proportion having received them (Figure 2).
Figure 2: Access to and need for hormone therapy among AMAB respondents (N=111): progesterone, oestrogen and testosterone blockers.
Surgery and legal transition: the widest gaps of all
If hormone therapy access is poor, surgical access is nearly absent. Among AFAB, almost two thirds still need access to top surgery. Access to legal transition is scarce as well, with only 4% of respondents completing this step and 71.4% of respondents still wanting to do so.
When the system doesn’t deliver, people take risks
Lastly, 8.7% of respondents reported resorting to unapproved treatments to transition, highlighting the reality that if needs aren’t met, people will find their own way. To avoid dangerous treatments and adverse outcomes, access to care for TGD people needs to be restructured. The authors conclude by highlighting the need for comprehensive, affordable and accessible care for all.
Bibliography
Bust, L., Matyila, S. A., Welte, O., Xaba, N., Zintwana, Z., George, A., De Jong, M., & Kaplan, R. (2026). Gender-aNirming care in South Africa: A cross-sectional survey of transgender and gender-diverse people in the Eastern and Western Cape provinces, South Africa. South African Medical Journal, 116(1), 46–53. https://doi.org/10.7196/SAMJ.2026.v116i1.3253
Gender incongruence and transgender health in the ICD. (n.d.). World Health
Organization.
Malviya, A. (2024, July 3). Diversity is a source of strength, rather than a cause of division. United Nations.
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