Young transgender people in China are risking their lives and health by taking unsafe hormones and attempting surgery on themselves, according to researchers at Amnesty International.

An “alarming” lack of knowledge and expertise within the country’s public health system, as well as restrictive eligibility requirements, has made it almost impossible for trans people to access safe hormone therapy or other gender-affirming treatment, said the human rights group in a report published on Friday.

In China, trans people are classified as having a mental illness and require the consent of their families for sex reassignment surgery, the researchers found. The prevalence of discrimination and stigma means many choose not to tell their families.

“China is failing transgender people,” said Doriane Lau, China researcher at Amnesty. “Discriminatory laws and policies have left many people feeling they have no choice but to risk their lives by performing extremely dangerous surgery on themselves and seeking unsafe hormone drugs on the black market.”

Transgender people are “invisible” in China’s health system, Amnesty said. They face entrenched discrimination at home, school and at work, as well as when seeking healthcare. China has no LGBTI (lesbian, gay, bisexual, transgender, intersex) anti-discrimination laws.

There are no official estimates of the number of trans people in the country, or how many seek treatment. However, in 2017 a report stated that more than 1,000 people in the country had undergone gender-affirming surgery and 400,000 people were planning to do so.

Two of the 15 trans people interviewed by Amnesty researchers recalled their trauma after attempting gender-affirming surgery on themselves.

“I thought I was an abnormal person,” said Huiming*, 30, from Hangzhou, who was born with male sex characteristics but identified as female. Accessing treatment at a hospital was not an option, as she feared her family would reject her when she asked for their consent.

After unsuccessfully seeking out a black market doctor for gender-affirming surgery, in 2016 she attempted surgery on herself to get rid of her male genitals. “How could I explain this to my family? I was both happy and scared. I was scared because I was bleeding so badly, I could die right there. I feared I would still die a man, since I only did part of my surgery.”

Huiming, who was rushed to hospital after the attempt, eventually travelled to Thailand for treatment. Before the surgery, she came out as trans to her mother, who has now accepted her.

Other trans people told Amnesty of how they had resorted to buying potentially unsafe hormones online, via information on social media, without knowing whether the drugs were genuine, or if they might cause harmful side effects.

Shansan*, 21, a transgender man from Beijing, said: “I couldn’t tell if the drugs were authentic. I think there isn’t anything lethal in these drugs … but what better options do I have?”

Lau said: “The Chinese government can show it is serious in addressing discrimination against the LGBTI community by removing the barriers transgender people face when trying to access safe gender-affirming treatments.”

Peking University Third hospital, which opened in 2018, is the only multidisciplinary clinic in China that specialises in a range of gender-affirming treatments.

In March, the Chinese government accepted recommendations by the UN human rights council to legislate to ban discrimination against LGBTI people.

Amnesty’s local partners in China said they found it difficult to recruit interviewees on a large scale for the report due to fear of the potential repercussions of speaking openly.

* Names have been changed