Gender Care in South Africa

The Alteration of Sex Description and Sex Status Act 49 of 2003 allows a person’s sex to be changed in official records following medical treatment or in the case of intersex people.

Legal framework

The Alteration of Sex Description and Sex Status Act 49 of 2003 allows a person’s sex to be changed in official records following medical treatment or in the case of intersex people. South Africa also has a strong constitution that prohibits discrimination on the grounds of sex and sexual orientation.

Clinical care

Gender care in the public system is limited and concentrated in a handful of major hospitals in Pretoria, Cape Town and Johannesburg. Waiting times are long and the quality of care varies.

The procedure

The application is submitted through the Department of Home Affairs. Applicants must provide statements from two doctors regarding the treatment. The law does not require surgery on the reproductive organs; hormone treatment may be sufficient. In practice, applicants complain that officials nevertheless ask for proof of surgery and that procedures take years. There is no self-identification-based system.

Public and private care

The best-known public facility is the transgender clinic at Groote Schuur Hospital in Cape Town, which was established in 2009. Steve Biko Academic Hospital in Pretoria and Chris Hani Baragwanath Hospital near Johannesburg also provide care. The number of surgeries performed each year is small, meaning that the waiting list for surgery in the public system stretches over many years. Those who can afford it turn to private clinics; private insurers often do not cover the treatment.

Guideline

In 2021, the Southern African HIV Clinicians Society published a guideline for gender-affirming care in Southern Africa. It follows the affirmative model and is aligned with WPATH’s standards. South Africa has not conducted an independent systematic assessment of the evidence, as has been done in Finland, Sweden and England. What WPATH is and how the organisation develops its standards is explained at wpath.nl; the substantive objections are discussed in criticism of version 8 of the Standards of Care. The debate about the treatment of minors is primarily driven by doctors and parents who refer to the Cass Review. Other countries are covered under policy by country.