Gender-Affirming Hormone Therapy in Thailand: Why the Government Must Accelerate System Readiness

Gender-affirming hormone therapy is a vital component of transgender health care. It is not merely a cosmetic adjustment but a service that directly affects safety, psychological well-being, long-term stability, and overall quality of life. Hormone therapy aligns a person’s body with their gender identity, reducing distress and improving mental and physical health outcomes.

In 2025, Thailand made a major breakthrough when the National Health Security Office (NHSO) approved gender-affirming hormone therapy as a benefit under the Universal Coverage Scheme (UCS or “Gold Card”). However, the fact that the Transgender Health Advocacy Network and 23 civil society organizations submitted a formal letter to NHSO on November 20, 2025, to request updates on the progress clearly shows that “policy exists, but the service system is not fully ready.”

This article summarizes the current landscape of hormone services in Thailand and analyzes what the government must urgently improve to make this right fully accessible to transgender people across the country.

Current Situation of Hormone Services in Thailand

A Significant Gap Between National Policy and Actual Service Delivery

Although the policy has been officially announced, implementation remains slow. Many hospitals still cannot provide hormone therapy because of insufficient training, lack of standard clinical guidelines, and absence of proper laboratory monitoring systems. Several areas still struggle with limited hormone medication supply, which prevents the service from being delivered consistently.

As a result, many transgender people continue to buy hormones online or from unregulated pharmacies—posing serious long-term health risks such as incorrect dosage, infections, adverse effects, and complications that go undetected without proper blood monitoring.

Healthcare Personnel Are Not Yet Confident to Provide Hormone Services

Even hospitals willing to provide services often have staff who lack gender-affirming care knowledge, including:

• how to interpret blood tests
• how to choose appropriate hormone regimens
• how to assess medical risks
• how to offer non-discriminatory and respectful counseling
• Since most providers have never received formal training, many choose to “avoid providing the service” to prevent mistakes.

Attitudinal barriers also remain. Some providers still view gender affirmation as a non-essential service, resulting in insensitive or stigmatizing interactions that discourage transgender people from seeking care.

Services Are Concentrated in Large Cities; Smaller Provinces Have No Access

Transgender people in Bangkok, Chiang Mai, Khon Kaen, or Phuket may access hormone services more easily, but many provinces still lack any transgender-competent service providers. People in rural areas often need to travel long distances or may stop treatment entirely due to travel costs.

This geographic inequity highlights a systemic failure: “services are not yet nationwide,” even though the right already exists.

Most People Still Don’t Know Hormone Therapy Is Covered by UCS

Despite being added to the benefits package, public communication remains unclear. Many transgender people are unsure about:

• whether the service has officially started
• which hospitals provide it
• whether they meet the criteria
• whether they must pay out of pocket

This confusion leads many to avoid the public health system and continue using unsafe hormone products—even though they now have legal coverage.

What the Government Must Urgently Improve

Expand Service Availability Across All Provinces

The government should equip provincial hospitals, district hospitals, and family clinics to provide gender-affirming hormone services. This includes building capacity for laboratory testing, counseling, and safe medication dispensing. Expanding service coverage will reduce inequality and prevent transgender people from traveling long distances for essential care.

Develop a National Clinical Guideline for Gender-Affirming Hormone Therapy

• A standardized guideline is essential for service consistency nationwide. It should outline:
• the steps for pre-treatment assessment, including physical exams and blood tests
• a clear protocol for ongoing monitoring, evaluating hormone levels, identifying side effects, and adjusting treatment appropriately
• Such guidelines will ensure safety, reduce service variation, and help healthcare professionals feel confident in delivering care.

Train Healthcare Providers to Improve Both Clinical Skills and Attitudes

• Training should address medical knowledge as well as gender-sensitive care, including:
• endocrine principles, blood-test interpretation, and long-term monitoring
• respectful communication, understanding gender identity, and reducing stigma
• Well-trained providers will help ensure services are high-quality, compassionate, and widely available.

Improve Public Communication About Hormone Coverage Under UCS

NHSO should collaborate closely with hospitals, civil society, and transgender communities to disseminate information across online platforms, clinics, and local networks. Clear and continuous communication will reduce misinformation, encourage service uptake, and help the public trust the healthcare system.

Establish a Joint Working Group Between Government and Transgender Communities

Transgender-led organizations understand real-world barriers, such as lack of physicians, long waiting times, and administrative obstacles. A formal working group will ensure that policies are grounded in lived experiences, and that system development responds to actual needs—not assumptions.

Making Hormone Services Truly Accessible Is the Key to Health Equity

Thailand’s decision to include gender-affirming hormone therapy in UCS is a landmark achievement. However, the work is far from complete. Implementation needs rapid and sustained improvements—expanding service coverage, establishing clinical standards, training providers, and effectively communicating public benefits.

When hormone services become fully accessible, nationwide, and free from discrimination, Thailand will take a major step toward a health system that honors the dignity of every person. Only then will transgender people across the country receive the care, respect, and rights they fundamentally deserve.