It’s not uncommon for transgender people to get a negative reaction from their parents when they come out. But parental support is particularly crucial in China, where trans people need parental consent to undergo gender-affirming surgery and change their legal gender — even as adults. (If their parents are deceased, trans people must prove that to authorities.) These hurdles often make it harder for trans people to obtain care.

Lee, who wanted to pursue the surgery, said he considered the consent requirement an effort to prevent parents from seeking legal or physical retribution against doctors. “They’ll make a scene,” he said of parents who may not support their child’s decision to undergo surgery. “There will be family members taking out knives to kill doctors. It will become a social issue.”

That was one of the reasons Lee didn’t pursue gender-affirming surgery in China. “My mom is conservative,” he said. Though consent forms can be forged, he didn’t want her to go after the doctor who helped him.

In China, the need to obtain parental consent for gender-affirming care forces families to resolve their differences about the procedure ahead of time, dealing with drama or disagreements inside the family. According to Cherry, an LGBTQ+ organization worker, who requested the use of a pseudonym to protect their safety, the requirement exists to avoid parents causing a stir at the hospital.

It is also the product of a Confucian and patriarchal way of organizing society, Cherry said. For instance, police who want to put pressure on young queer activists often visit their parents’ workplaces and out them — so that the target has to deal with the ensuing family drama. “The person is managed through the family so they don’t become a problem in the public domain,” Cherry said.