Hong Kong CNN  — 

Largely forgotten by China’s health system, young transgender men and women are turning to dangerous alternatives such as a black market drugs and even life-threatening self surgery, according to a new report.

The study by human rights group Amnesty International, released Friday, reveals how China’s transgender people face both widespread discrimination and daunting obstacles to important gender-affirming treatments.

“Interviewees give examples of them being discriminated against at work, being told by employers not to wear (their) hair long, or not to wear to wrong clothes – ‘You’re driving away customers.’ At home their family will tell them to suppress their gender identity: ‘Be a man or have a child,’” Amnesty International China researcher Doriane Lau told CNN.

Ran, one of the gender non-binary trans people interviewed by Amnesty, uses they/them pronouns. Their T-shirt reads "I am a transgender person, can you hug me?"

Lau said the consequences of the discrimination and isolation can be disastrous. One 30-year-old transgender woman, Huiming, told researchers when she was unable to obtain hormone treatment legally, she began to self-medicate in large doses in a desperate attempt to reconcile her body with her identity.

Eventually, afraid to tell her family but desperate for surgery, she took matters into her own hands. “She tried putting ice on her male genitals to stop them functioning and even booked a surgery with a black-market doctor, but the doctor was arrested,” the report said.

“Convinced that she had no way out, Huiming finally tried performing surgery on herself at home in mid-2016.”

Discrimination and fear

For many transgender people, gender-affirming treatments, including hormone therapy or surgery, can end years of damaging anxiety and discomfort caused by their physical appearance not matching their sense of self.

According to a study published in the journal Pediatrics in 2018, transgender young people are at an unusually high risk of self harm. More than half of US transgender male teens interviewed in the study said they had tried to kill themselves.

“For example, if I was transgender, I might look at myself and I feel that I’m a man, but when I hit puberty then I develop secondary sex characteristics that are very feminine and that mismatch can incite a very great deal of discomfort, anxiety and depression,” Lau said.

In China there is barely any mention of transgender issues in law, nor any official statistics. With little reliable Chinese-language information, young transfolk can end up seeking help from unofficial sources, potentially exposing them to bad or unsafe advice.

Even those who go through proper channels find doctors who don’t know how to treat them, or who believe they’re mentally ill, the report says.

Under China’s Sex Reassignment Procedural Management Standards 2017, “transsexual” people face a strict criteria before undergoing gender-affirming surgery.

According to the law, they must be older than 20, unmarried and have undergone psychological therapy for a year prior. They also have to demonstrate they’ve been wanting the surgery for five years “with no history of hesitation.”

Finally, they must have familial consent, regardless of their age.

Chen said that, unable to find safe doctors in China, some of his friends had gone to Thailand for gender-affirming surgery.

CNN has reached out the Chinese government for comment. According to the report, Amnesty contacted the Chinese government prior to its release, but requests for comment went unanswered.

Difficulty in obtaining hormone therapy has driven some people online or to the black market, where they risk taking counterfeit and unsuitable medications with little information on dosage or side effects.

More terrifying than side effects

“In China, very few hospitals prescribe hormones and it’s super expensive. So many buy hormone products online or via word-of-mouth,” 24-year-old transgender man Chen Xu told CNN.

One transgender woman, identified by the pseudonym Ping, said that she began to take large doses of the medication without proper advice from a medical professional.

“I suffered from severe side effects – I wanted to get obvious results so I took a lot. I suffered from nosebleeds, insomnia, dizziness and fatigue,” she said.

But she didn’t want to stop. “Being a man is more terrifying than suffering from all these side effects.”

Out of the 15 transgender people interviewed for the report, two said they attempted to perform gender-affirming surgery on themselves as a last resort.

Huiming, the transgender woman who performed surgery on herself, survived her attempts to get rid of her male sexual characteristics.

Bleeding profusely, she rushed to hospital, but she said the experience led her to accept she couldn’t change who she was. She came out to her family and had proper gender-affirming surgery in Thailand. “My mother was a bit frustrated, but she accepted me,” she told Amnesty.

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‘These things will keep happening’

Lau said that without changes to China’s laws, which treat the issue like a mental health disorder, Huiming’s story will be repeated again and again.

“These things will keep on happening,” she said.

“When I ask them what you think should be done to make your lives easier, almost all of them say they hope society will accept them.”

Later this year, the World Health Organization will begin discussion to end the definition of transgenderism as a mental illness, instead regarding it as a sexual health condition.

The change is expect to come into place by 2022.

Lau said she wanted to see similar action taken by the Chinese government. “If the definition is changed, it means the classification of treatment is changed,” she said.

CNN’s Serenitie Wang contributed to this article.