Abstract
The development of health service systems that respond to the specific needs of transgender
and gender-diverse people (TGD) is a critical issue for advancing health equity and the protection of
human rights in Thailand. Although Thailand has made notable progress over the past decade in terms
of social and cultural recognition of gender diversity, in practice transgender and gender-diverse people
continue to face substantial structural, social, and economic barriers in accessing gender-affirming
hormone therapy and related health services. These barriers are particularly evident in the absence of
systematic inclusion of such services within public health benefit packages and in the concentration of
specialized services in urban areas.
The overall objective of this study is to develop policy recommendations to promote access to
gender-affirming hormone therapy and related services for transgender and gender-diverse people in
Thailand. The specific objectives are to: (1) examine service delivery models and care pathways for
gender-affirming hormone therapy across different types of health service providers; (2) analyze
structural, social, economic, and health system factors influencing access to services from the
perspectives of both service users and service providers; and (3) synthesize empirical findings into policy
recommendations aimed at developing a health service system that is comprehensive, high-quality,
accessible, and capable of reducing stigma and discrimination.
This study employed a mixed methods research design and was conducted between February
2024 and April 2025. The research methods included a review of relevant literature and clinical
guidelines, an online cross-sectional survey of 521 transgender and gender-diverse individuals and 7
health service providers, in-depth interviews with 15 service users and representatives from 11 health
service providers, observations of health facilities, and four policy dialogue workshops held in Bangkok,
Chonburi (Pattaya), Chiang Mai, and Nakhon Ratchasima. These workshops facilitated joint analysis and
policy design with stakeholders from multiple sectors.
The findings indicate that the current system of gender-affirming hormone services in Thailand
comprises three main types of providers: community-based organization clinics, hospitals and public
health centers, and pharmacies. Each provider type plays a distinct role and demonstrates different
strengths and limitations. Community-based organization clinics are particularly effective in reaching
target populations and providing gender-affirming and user-friendly services. Hospitals offer
comprehensive clinical standards but remain limited in accessibility, while pharmacies have high
potential as frontline access points for hormone therapy but lack adequate quality assurance
mechanisms and integration with other health services. Factors significantly associated with access to
services include educational attainment, type of service provider, out-of-pocket costs, and the attitudes
of healthcare personnel. Although overall satisfaction with services was high, key barriers persist,
including financial burden, procedural complexity, and stigma within the health system. These
challenges lead some individuals to obtain hormones from unregulated sources, increasing health risks.
Based on these findings, the study proposes three strategic directions for health system
development: (1) inclusion of gender-affirming hormone therapy and related health services within
public health benefit packages; (2) expansion of services to the community level with communitybased organizations as central actors; and (3) development of integrated one-stop service models,
alongside short- and long-term policy measures that strengthen collaboration among government
agencies, the private sector, and civil society. The study concludes that access to gender-affirming
hormone therapy is not merely a medical issue, but a matter of rights, well-being, and social justice,
requiring systematic and sustainable policy action within the Thai context.
