Every week, Huynh Nha An faces the same dilemma: spend her paltry salary on food, or buy the black market hormones she needs to keep her facial hair from growing back.
Born male but desperate to change sex, the timid 21-year-old self-prescribes and injects drugs bootlegged from Thailand — when she can afford them.
“When I don’t use hormones regularly I turn back into a boy, I’m no longer smooth like a girl,” explains the street food seller and part-time singer.
Nha An is one of thousands facing the same problem in Vietnam, where hormone therapy and sex-reassignment surgery are not legally available to transgender people.
That forces many to self-medicate despite the serious health risks.
The transgender community endures discrimination in many parts of Vietnam, a communist-controlled country where conservative social mores dominate.
But in a rare act of social progression, the government is writing a law that will allow people to officially change their gender.
That could result in better access to healthcare for Vietnam’s 300,000-strong transgender community, but it will not become law until 2019 at the earliest.
Until then Nha An will have to get along without specialist medical help, relying on friends for advice on the dosage and frequency of her hormone injections.
Some months she spends nearly half her $100 income on the drugs, or borrows from friends — her family stopped giving her money after she ran away from home.
“My parents still see me as a diseased person, they don’t accept me as a girl,” she said.
– ‘I still have a scar’ –
For trans women like Nha An, it’s tough to find estrogen and progesterone under the table in Vietnam, which is why she buys drugs brought in from Thailand.
But trans men have an easier time finding male hormones, since they’re more commonly available over the counter as a muscle enhancer or libido booster.
Nha An has been lucky so far: doctors warn unsupervised hormone therapy can lead to liver damage, blood clots or high blood pressure.
Jessica Nguyen has not been as fortunate. She developed an abscess after injecting hormones into her behind.
“There is still a scar on my bum,” said the 31-year-old from her costume shop festooned with feather boas and sequined headdresses in Ho Chi Minh City.
She’s seen other friends go in and out of hospital: one who mistakenly injected hormones into her bloodstream, and another whose arm went numb after a dangerously high dose.
Jessica wants better access to safe treatments in Vietnam, including sex-reassignment surgery, which she paid $4,000 for in Thailand — a small fortune for most Vietnamese.
She had her breasts done for $1,800 in Vietnam, a procedure available to trans people if they can find a surgeon, with no law explicitly banning the procedure.
“I felt like a different person… I am happy with my body now,” said Jessica, who left home when she was 20 after her parents approached shamans and doctors to cure her transgender “sickness”.
– ‘Cultural barriers’ –
If Vietnam enacts the new law it will be among the first countries in Southeast Asia to allow trans people to legally change their identities.
Activists want to ensure the law is as wide-ranging as possible.
The health ministry said it is considering whether to legalise hormone therapy and sex-reassignment surgery as part of the law.
“We have to assess what medical facilities will be compatible to do hormone therapy or surgery for trans people,” said Nguyen Huy Quang, head of health legislation at the ministry.
The law will also determine who is allowed to change their gender legally. So far people who are not on hormone therapy or who have not had surgery will not qualify.
“There would be some legal barriers as well as psycho-social and traditional cultural barriers,” he told AFP.
For men like Phong Nguyen, who was born female but identifies as male, that is bad news.
He has stopped taking hormones and does not plan to have surgery, which means that even though he lives his life as a man, his identification card still says he is a woman.
The result is a bureaucratic nightmare when applying for jobs or opening bank accounts.
“The law has to be for anyone who identifies as transgender, no matter what their physical condition is,” said Phong, an activist at non-profit group, ICS.
– Morning-after pills –
While they wait for the law to change, Vietnam’s trans community has little choice but to seek out black market hormones.
Trans twins Truc Lam and Truc Linh used to take fistfuls of morning-after pills every day, eager to grow breasts — though they were well-aware of the risks.
“We did it secretly and by ourselves,” Lam told AFP.
“I wanted my transition to be quick, I wanted to be beautiful.”
A decade on and hormones are easier to find, but still, they worry about the law, uncertain about its implications for them.
“It’s good to have someone who could supervise us in using hormones, it could assure us about our health, but it could cost us more money,” said Linh.
“I hope the government can help on this.”