The Gold Card hormone therapy is not for cosmetic purposes; it reveals the conditions and procedures for transgender and gender-diverse individuals to access their rights.
The National Health Security Office (NHSO) has expanded Gold Card benefits to include comprehensive hormone therapy services for gender affirmation, covering medication, laboratory testing, and mental health care to reduce financial burdens and increase safety for those requiring hormone therapy, all under medical supervision.
This has sparked controversy over the appropriateness of allocating budget to this project amid limited healthcare funds and the need to prioritize spending carefully.
Thairath Online’s special reporting team interviewed Ms. Natchalee Boonyapismpar, Vice President of the Transgender Friends Network Foundation for Human Rights, who said the overall system has not yet fully launched everywhere because the NHSO is still in the process of registering medical facilities as service units and conducting standard assessments.
Recently, an online meeting was held regarding the registration of service units, and currently about 22 units have registered, mostly concentrated in Bangkok, with some in provinces such as Korat, Ubon Ratchathani, and Chiang Mai.
Regarding online rumors claiming “service appointment queues are booked until next year,” Ms. Natchalee explained this likely refers to one clinic, a civil society multiservice clinic that previously offered these services and has seen high demand since the benefit package was introduced, filling its schedule through next year. Other medical facilities are still awaiting further clarification.
According to the NHSO’s payment manual for hormone therapy services for transgender and gender-diverse adults or late adolescents, the target group is Thai transgender and gender-diverse individuals with a medical necessity for gender affirmation, aged 18 or older.
Ms. Natchalee views this benefit package as covering a full range of gender affirmation hormone services, including medication (about six drugs available for transgender men and women), lab tests, and mental health care, with key conditions as follows.
1. Age restriction: recipients must be 18 years or older; children are excluded, and hormone blocker drugs are not covered.
2. Medical evaluation is required; individuals cannot simply request medication without assessment. They must go through medical records, consult a doctor for mental health evaluation, and have blood tests to measure hormone levels before therapy design.
3. Follow-up system: blood tests and side effect monitoring must occur every 3, 6, or 12 months to safely and appropriately adjust dosages for each individual.
According to the NHSO’s payment manual for hormone therapy services for transgender and gender-diverse adults or late adolescents,
the steps for providing gender affirmation hormone therapy services are as follows.
Comprehensive health counseling (physical, mental, and social), including an overview of the gender affirmation process with or without medication, surgical options, pros and cons of each, and possible outcomes if the process is discontinued after starting.
Diagnosis and assessment of gender incongruence.
Comprehensive health evaluation.
Provision of gender affirmation hormone therapy.
Monitoring and follow-up of hormone therapy services.
Regarding the budget controversy amid limited public health funds, Ms. Natchalee offered an insightful perspective that society often mistakenly believes the NHSO must allocate funds to purchase new drugs specifically for transgender people. In reality, transgender hormones are not new medicines but are existing drugs in Thailand’s pharmaceutical inventory.
"Hormones are not exclusively for transgender people. General men and women with hormonal deficiencies, such as menopausal women or men with erectile dysfunction, also use these same existing drugs, though treatment goals and dosages differ."
"Accessing hormone therapy for gender affirmation is not about beauty," Ms. Natchalee said.
In our country, hormone therapy is still viewed as a cosmetic issue, but it is much more than that. Achieving a body that aligns with one’s gender identity is the simplest and most cost-effective first step, which improves confidence and mental health significantly.
Therefore, proper access to hormones is not a matter of "beauty" but of "well-being and safety." Many transgender people have had to buy medications themselves from pharmacies or use contraceptive pills off-label, which is improper and may cause serious long-term side effects. Bringing hormone therapy under the Gold Card and expert medical care reduces the risk of severe illness and will lower state healthcare costs in the long run, similar to models in other countries like New York City, USA, where health insurance systems recognize this as an essential health right.
For those interested in services, Ms. Natchalee advises choosing a nearby facility because hormone therapy for gender affirmation requires continuous doctor visits for blood tests and dosage adjustments. Choosing a hospital that is hard to reach may disrupt treatment continuity. She recommends following official announcements of registered service units from the NHSO.
Ms. Natchalee concluded by urging society to open its mind to acceptance of diversity, noting that humans are not all the same and everyone has different needs, including health needs.
"No health difference is more important than another. If we open our minds, we will find we can coexist by respecting differences and valuing every issue and every person," Ms. Natchalee said in closing.