Few specialists, high costs widen transgender healthcare gap

(Last of two parts)

DUMAGUETE CITY, NEGROS ORIENTAL, Philippines — For many transgender Filipinos, the decision to transition does not begin inside a doctor’s clinic—it begins in Facebook groups, chat conversations or recommendations from friends.

Outside major cities, where access to doctors trained in transgender healthcare remains limited, many rely on online advice and self-medication, often without fully understanding the health risks involved.

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The situation is particularly difficult in smaller provinces, where access to specialists and laboratory services is scarce.

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“Not everyone has access to professionals who specialize in transgender health. Even laboratory facilities capable of monitoring hormone levels are unavailable in many areas,” said Dr. Vincent Martin Bravo, a local endocrinologist who specializes in transgender healthcare.

READ: Transgender Filipinos face risks from self-medication, experts warn

He noted that many of his transgender patients in Dumaguete still need to travel to Cebu or Metro Manila just to undergo specialized laboratory tests.

“Laboratory tests, consultations and medications are expensive. Many cannot afford them, so they rely on information from friends or online communities,” Bravo said in a recent interview.

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Bravo said relying on online information or peer recommendations is common—but potentially dangerous.

READ: Group seeks PhilHealth package for transgenders

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“Many transgender individuals learn what medications to take from friends or online communities. But what works for one person may not work for another,” he said.

Hormone therapy, Bravo explained, must be individualized based on a person’s medical history, current health condition and laboratory results.

According to Bravo, about 80 percent of his transgender patients seek professional care only after they have already begun self-medicating or experienced complications.

“Only around 20 percent seek professional guidance before starting hormone therapy,” he said.

Unsupervised hormone use can lead to blood clots, cardiovascular disease, breathing problems, hormonal imbalances and other potentially life-threatening complications.

Bravo believes one reason many transgender Filipinos resort to self-medication is the absence of transgender healthcare from the country’s public health system.

Gov’t support

According to Bravo, government support through free consultations, laboratory testing, and access to medications would significantly improve health outcomes.

To address these gaps, the Philippine College of Endocrinology is mapping physicians across the country who provide gender-affirming healthcare.

The initiative seeks to identify areas with limited access to specialists and strengthen referral networks.

“Unlike diabetes or hypertension, transgender healthcare is not readily available in most primary healthcare facilities,” Bravo said.

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Health experts also warn that hormone therapy is only one of the health risks facing transgender women. Dr. Troy Recomo of the Aesthetic Medicine Institute of the Philippines said illegal cosmetic injections and enhancement procedures performed by unlicensed practitioners continue to endanger lives. For both Bravo and Recomo, gender affirmation should never come at the expense of health. /cb