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It Is Supposed to Be Primary Care, Yet Transgender People Must Travel Long Distances for Hormone Treatment
2026-09-18 14:33
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KITE research team holds presentation of 2025 survey findings on the 7th
High satisfaction even after five to ten years of long-term hormone treatment
Some undergo unwanted surgery for legal gender recognition; mental health indicates a “high-risk group for suicide”
Hormone treatment showed high satisfaction even after long-term use during the gender-affirming care process of transgender and gender-diverse people. However, limitations in access to healthcare and serious mental-health concerns remain.
The study also identified cases in which people gave up fertility preservation because of financial burdens or endured surgery they did not want in order to obtain legal gender recognition.
The Korean Initiative for Transgender Health (KITE) research team held the “KITE 2025 Research Findings Presentation” on the 7th at Il-song Hall, Kangdong Sacred Heart Hospital.
At the presentation, Professor Sunyoung Lee of the Public Healthcare Center at Seoul National University Hospital presented the KITE 2025 findings and future plans.
KITE is a multicenter prospective cohort study involving eight medical institutions that provide gender-affirming healthcare. It enrolls transgender people who have already received hormone therapy or surgery and follows them for several years to examine changes in their health.
The study began in December 2023, and the results of the first survey conducted in 2024 were released in January 2025. In 2025, the team conducted a one-year follow-up survey and recruited new participants. As of 2026, the research is focusing on long-term follow-up and surgical outcomes.
A total of 956 people responded to the 2025 survey. Approximately 79% of the 2024 respondents participated again, showing a high follow-up rate. There were 288 newly enrolled participants, including 129 people who were beginning hormone treatment.
Participants consisted of 50% trans women, 30% trans men, and 20% nonbinary people, with a median age of 28. The median age of those newly beginning hormone treatment was 25.
Hormone-Treatment Satisfaction Exceeds 90%; Long-Term Use Evaluated Positively
Overall satisfaction with hormone treatment was high, at 94% among trans men and 90% among trans women. In addition to improved gender congruence and a positive effect on gender expression, many participants reported improvements in quality of life, self-esteem, and mental health.
The study also analyzed long-term use. Among 806 participants with hormone-treatment experience, 85 had used hormones for at least ten years and 305 had used them for at least five years. Participants who had used hormones for more than 20 years were also included. Satisfaction was 95% among those with at least ten years of use and 88% among those with at least five years of use.
Professor Lee explained, “This does not mean that satisfaction increases simply because hormones are used for a long time. Rather, it shows people who are concerned about whether five or ten years of treatment is safe that actual long-term users also evaluate the treatment positively.”
In the analysis of self-perceived effects, participants who had used hormone treatment for a longer period also reported higher satisfaction than those in the early stages of treatment. Professor Lee interpreted this as reflecting the fact that it takes approximately one year for the physical effects of hormone treatment to become stable.
The influence of hormone treatment was also seen in the body-image survey, which measured how participants perceived their own bodies. The median body-image score among transgender respondents was 1.8, far below the Korean adult average of 3.57 reported in a previous study. However, scores rose with the duration of hormone treatment: 1.6 among participants who had just started treatment and 2.2 among those who had used hormones for at least ten years.
Transgender People Are a High-Risk Group for Suicide; Mental Health Becomes More Stable with Age
Mental-health indicators remained serious. The proportions of participants who had received psychiatric diagnoses were 35% for depression, 20% for anxiety disorders, and 15% for sleep disorders, highlighting the need for support to improve the vulnerable mental health of the transgender population.
During the previous year, 30% had experienced suicidal thoughts, 14% had made a suicide plan, and 6% had attempted suicide. Compared with findings for the general population, the rates of suicidal thoughts and plans were more than 20 times higher, while the rate of suicide attempts was more than 50 times higher.
Professor Lee emphasized that transgender people constitute a high-risk group for suicide but have not received sufficient social attention.
Although the government recognizes suicide as a serious social disaster, has established a national suicide-prevention strategy, and conducts surveys on suicide, LGBTQ+ populations, including transgender people, remain invisible and are left in a blind spot within suicide-prevention policy.
LGBTQ+ people are also not included as a target population in plans intended to identify and respond to high-risk groups at an early stage. The researchers therefore called for policies that actively identify and support at-risk populations currently excluded from policy.
One notable finding was that mental health was comparatively more stable at older ages. Age-based analysis of suicide and self-harm showed that suicidal thoughts, which exceeded 30% among people in their early twenties, decreased to 15% among people aged 40 and older. The findings point to the need for particular attention to mental-health protection and suicide prevention among transgender people in their twenties.
People Know About Fertility Preservation but Cannot Access It Because of Cost
More than 90% of respondents knew that fertility-preservation methods existed, but access to specific information was limited. Although 50% had received an explanation from a healthcare professional, only 30% of that group had received information covering costs, institutions providing preservation services, and methods for future use.
More than 30% of respondents had already undergone gonadectomy, while only two had actually preserved their fertility. Reasons for not doing so more often included expectations that future use would be difficult and financial burden than not wanting children. Even among participants who said that they did not intend to preserve fertility in the future or were uncertain, 30% identified cost as a major reason.
The cost of fertility-preservation procedures, which can amount to hundreds of thousands of Korean won, was analyzed as a significant barrier for transgender people in their mid-twenties, the period when gender-affirming healthcare commonly begins.
Notably, 10% of respondents who had not preserved fertility said that they would have done so if they had known about it beforehand. This demonstrates the need to provide information and institutional support for fertility preservation as part of gender-affirming healthcare.
One in Five Transgender People Cannot Visit a Hospital Even When Ill
Problems with access to healthcare were also prominent. More than 95% could reach a hospital for general medical care within one hour, but more than 60% had to travel for at least one hour to receive hormone treatment. More than 10% traveled for at least two hours, and some respondents reported journeys of three hours or longer.
Professor Lee explained, “The World Professional Association for Transgender Health guidelines define transgender hormone treatment as primary care that should be conveniently available within the community, like treatment for diabetes or hypertension. Access remains low in Korea. Many people invest more than an hour in a hospital visit for hormone treatment for various reasons, including the absence of nearby institutions providing treatment or a lack of affirming services.”
Participants also experienced difficulties when using medical services unrelated to gender-affirming care. Among respondents with experience using medical institutions, 70% felt that healthcare professionals did not understand transgender people well. Fifty percent had disclosed that they were transgender at a hospital but said they experienced difficulty because the clinicians lacked knowledge about transgender people and gender-affirming healthcare.
Forty percent reported experiencing discrimination at a medical institution. Examples included being repeatedly asked to confirm their sex, receiving unnecessary questions, or being refused treatment after disclosing a transgender identity.
Twenty percent reported that they had been unable to visit a hospital despite being ill during the previous year because they feared discrimination; the lifetime rate exceeded 30%. This was approximately 2.5 times the annual unmet healthcare rate of 8% among the Korean population reported in the Korea National Health and Nutrition Examination Survey conducted by the Korea Disease Control and Prevention Agency in 2024.
Unwanted Surgery Is a Barrier to Legal Gender Recognition
Twenty-five percent of respondents had completed legal gender recognition, but the rate among trans women was only 16%. By contrast, 68% of trans women said that they wanted to obtain legal gender recognition in the future, demonstrating the substantial institutional barriers they face.
Among people who had completed legal gender recognition, 10% said that they had undergone surgery they did not want in order to change their legal gender. In particular, 14% of trans men who had changed their legal gender reported undergoing an unwanted hysterectomy for that purpose. Even among those who said that they did not want legal gender recognition, 20% cited the difficulty of the process and the requirement to undergo unwanted medical procedures as reasons.
Professor Lee stated, “Forcing surgery as a requirement for legal gender recognition violates bodily autonomy. Unclear requirements and procedures function as structural barriers that obstruct legal gender recognition.”
The KITE research team has already begun its 2026 survey. This year's research addresses changes in body image, the long-term effects of gender-affirming healthcare, a one-year follow-up of hormone treatment, and gender-affirming surgery.
KITE aims to conduct long-term follow-up for up to ten years. Because LGBTQ+ communities are also paying close attention to the long-term findings, their sustained interest and participation will be essential to completing the follow-up research.
The KITE study is supported by the National Research Foundation of Korea with funding from the Korean government, Ministry of Science and ICT (No. RS-2024-00335223).
Medifonews, reporter Younghee Noh
Source: https://www.medifonews.com/mobile/article.html?no=211136#
High satisfaction even after five to ten years of long-term hormone treatment
Some undergo unwanted surgery for legal gender recognition; mental health indicates a “high-risk group for suicide”
Hormone treatment showed high satisfaction even after long-term use during the gender-affirming care process of transgender and gender-diverse people. However, limitations in access to healthcare and serious mental-health concerns remain.
The study also identified cases in which people gave up fertility preservation because of financial burdens or endured surgery they did not want in order to obtain legal gender recognition.
The Korean Initiative for Transgender Health (KITE) research team held the “KITE 2025 Research Findings Presentation” on the 7th at Il-song Hall, Kangdong Sacred Heart Hospital.
At the presentation, Professor Sunyoung Lee of the Public Healthcare Center at Seoul National University Hospital presented the KITE 2025 findings and future plans.
KITE is a multicenter prospective cohort study involving eight medical institutions that provide gender-affirming healthcare. It enrolls transgender people who have already received hormone therapy or surgery and follows them for several years to examine changes in their health.
The study began in December 2023, and the results of the first survey conducted in 2024 were released in January 2025. In 2025, the team conducted a one-year follow-up survey and recruited new participants. As of 2026, the research is focusing on long-term follow-up and surgical outcomes.
A total of 956 people responded to the 2025 survey. Approximately 79% of the 2024 respondents participated again, showing a high follow-up rate. There were 288 newly enrolled participants, including 129 people who were beginning hormone treatment.
Participants consisted of 50% trans women, 30% trans men, and 20% nonbinary people, with a median age of 28. The median age of those newly beginning hormone treatment was 25.
Hormone-Treatment Satisfaction Exceeds 90%; Long-Term Use Evaluated Positively
Overall satisfaction with hormone treatment was high, at 94% among trans men and 90% among trans women. In addition to improved gender congruence and a positive effect on gender expression, many participants reported improvements in quality of life, self-esteem, and mental health.
The study also analyzed long-term use. Among 806 participants with hormone-treatment experience, 85 had used hormones for at least ten years and 305 had used them for at least five years. Participants who had used hormones for more than 20 years were also included. Satisfaction was 95% among those with at least ten years of use and 88% among those with at least five years of use.
Professor Lee explained, “This does not mean that satisfaction increases simply because hormones are used for a long time. Rather, it shows people who are concerned about whether five or ten years of treatment is safe that actual long-term users also evaluate the treatment positively.”
In the analysis of self-perceived effects, participants who had used hormone treatment for a longer period also reported higher satisfaction than those in the early stages of treatment. Professor Lee interpreted this as reflecting the fact that it takes approximately one year for the physical effects of hormone treatment to become stable.
The influence of hormone treatment was also seen in the body-image survey, which measured how participants perceived their own bodies. The median body-image score among transgender respondents was 1.8, far below the Korean adult average of 3.57 reported in a previous study. However, scores rose with the duration of hormone treatment: 1.6 among participants who had just started treatment and 2.2 among those who had used hormones for at least ten years.
Transgender People Are a High-Risk Group for Suicide; Mental Health Becomes More Stable with Age
Mental-health indicators remained serious. The proportions of participants who had received psychiatric diagnoses were 35% for depression, 20% for anxiety disorders, and 15% for sleep disorders, highlighting the need for support to improve the vulnerable mental health of the transgender population.
During the previous year, 30% had experienced suicidal thoughts, 14% had made a suicide plan, and 6% had attempted suicide. Compared with findings for the general population, the rates of suicidal thoughts and plans were more than 20 times higher, while the rate of suicide attempts was more than 50 times higher.
Professor Lee emphasized that transgender people constitute a high-risk group for suicide but have not received sufficient social attention.
Although the government recognizes suicide as a serious social disaster, has established a national suicide-prevention strategy, and conducts surveys on suicide, LGBTQ+ populations, including transgender people, remain invisible and are left in a blind spot within suicide-prevention policy.
LGBTQ+ people are also not included as a target population in plans intended to identify and respond to high-risk groups at an early stage. The researchers therefore called for policies that actively identify and support at-risk populations currently excluded from policy.
One notable finding was that mental health was comparatively more stable at older ages. Age-based analysis of suicide and self-harm showed that suicidal thoughts, which exceeded 30% among people in their early twenties, decreased to 15% among people aged 40 and older. The findings point to the need for particular attention to mental-health protection and suicide prevention among transgender people in their twenties.
People Know About Fertility Preservation but Cannot Access It Because of Cost
More than 90% of respondents knew that fertility-preservation methods existed, but access to specific information was limited. Although 50% had received an explanation from a healthcare professional, only 30% of that group had received information covering costs, institutions providing preservation services, and methods for future use.
More than 30% of respondents had already undergone gonadectomy, while only two had actually preserved their fertility. Reasons for not doing so more often included expectations that future use would be difficult and financial burden than not wanting children. Even among participants who said that they did not intend to preserve fertility in the future or were uncertain, 30% identified cost as a major reason.
The cost of fertility-preservation procedures, which can amount to hundreds of thousands of Korean won, was analyzed as a significant barrier for transgender people in their mid-twenties, the period when gender-affirming healthcare commonly begins.
Notably, 10% of respondents who had not preserved fertility said that they would have done so if they had known about it beforehand. This demonstrates the need to provide information and institutional support for fertility preservation as part of gender-affirming healthcare.
One in Five Transgender People Cannot Visit a Hospital Even When Ill
Problems with access to healthcare were also prominent. More than 95% could reach a hospital for general medical care within one hour, but more than 60% had to travel for at least one hour to receive hormone treatment. More than 10% traveled for at least two hours, and some respondents reported journeys of three hours or longer.
Professor Lee explained, “The World Professional Association for Transgender Health guidelines define transgender hormone treatment as primary care that should be conveniently available within the community, like treatment for diabetes or hypertension. Access remains low in Korea. Many people invest more than an hour in a hospital visit for hormone treatment for various reasons, including the absence of nearby institutions providing treatment or a lack of affirming services.”
Participants also experienced difficulties when using medical services unrelated to gender-affirming care. Among respondents with experience using medical institutions, 70% felt that healthcare professionals did not understand transgender people well. Fifty percent had disclosed that they were transgender at a hospital but said they experienced difficulty because the clinicians lacked knowledge about transgender people and gender-affirming healthcare.
Forty percent reported experiencing discrimination at a medical institution. Examples included being repeatedly asked to confirm their sex, receiving unnecessary questions, or being refused treatment after disclosing a transgender identity.
Twenty percent reported that they had been unable to visit a hospital despite being ill during the previous year because they feared discrimination; the lifetime rate exceeded 30%. This was approximately 2.5 times the annual unmet healthcare rate of 8% among the Korean population reported in the Korea National Health and Nutrition Examination Survey conducted by the Korea Disease Control and Prevention Agency in 2024.
Unwanted Surgery Is a Barrier to Legal Gender Recognition
Twenty-five percent of respondents had completed legal gender recognition, but the rate among trans women was only 16%. By contrast, 68% of trans women said that they wanted to obtain legal gender recognition in the future, demonstrating the substantial institutional barriers they face.
Among people who had completed legal gender recognition, 10% said that they had undergone surgery they did not want in order to change their legal gender. In particular, 14% of trans men who had changed their legal gender reported undergoing an unwanted hysterectomy for that purpose. Even among those who said that they did not want legal gender recognition, 20% cited the difficulty of the process and the requirement to undergo unwanted medical procedures as reasons.
Professor Lee stated, “Forcing surgery as a requirement for legal gender recognition violates bodily autonomy. Unclear requirements and procedures function as structural barriers that obstruct legal gender recognition.”
The KITE research team has already begun its 2026 survey. This year's research addresses changes in body image, the long-term effects of gender-affirming healthcare, a one-year follow-up of hormone treatment, and gender-affirming surgery.
KITE aims to conduct long-term follow-up for up to ten years. Because LGBTQ+ communities are also paying close attention to the long-term findings, their sustained interest and participation will be essential to completing the follow-up research.
The KITE study is supported by the National Research Foundation of Korea with funding from the Korean government, Ministry of Science and ICT (No. RS-2024-00335223).
Medifonews, reporter Younghee Noh
Source: https://www.medifonews.com/mobile/article.html?no=211136#
