Available but insecure: Healthcare access and self-managed gender-affirming hormone use among trans women and trans men in Malaysia: A qualitative study

This qualitative study explored how trans women and trans men in Malaysia experienced healthcare access and how these experiences related to self-managed gender-affirming hormone use. It presents a focused analysis of interviews from a broader study of stigma, healthcare and support. Self-managed gender-affirming hormone use was defined as using feminising or masculinising hormones without formal prescription or ongoing clinical monitoring, including through pharmacies, peers, online sources or informal advice. Twenty-one transgender adults (18 trans women, 3 trans men; aged 25–55 years) participated in ten individual and four small-group interviews. Data were analysed using theory-informed thematic analysis drawing on the Minority Stress Model and Levesque's healthcare access framework. Three themes were identified. First, early bullying, family rejection, religious condemnation, anticipated rejection and concealment were described alongside long-term mental strain, while peer networks, community organisations and spiritual reinterpretation supported resilience. Second, healthcare was experienced as available but insecure: low-cost public services existed, but misgendering, legal name use, documentation barriers, privacy concerns and ward or toilet allocation were linked in participants' accounts to avoidance, delayed care and selective disclosure. Third, participants described gender-affirming hormone use as supporting embodiment, social affirmation and relief from distress, and described self-management alongside limited access to respectful, monitored services and concerns about side effects. Hormone use and health effects were self-reported and were not clinically verified. Findings reflect this community-linked sample. Respectful administrative practices, privacy-sensitive clinical encounters, accessible hormone-related support and community partnerships are changes worth considering.