How families shape the path to hormone replacement therapy for transgender and gender diverse youth in Singapore: a qualitative study

Objective In the context of youth gender-related medical decision-making, deliberations around hormone replacement therapy (HRT) are recognized as beginning within the family setting and marked by conversations, negotiations and agreements between transgender and gender diverse (TGD) youth and parents. How Singapore’s unique sociocultural context shapes familial negotiations for HRT is not understood from existing literature. The objective of this study is to explore how Singaporean TGD youth and parents reach, or fail to reach, an agreement on HRT.Methods We conducted semi-structured in-depth interviews with 13 TGD youths and 5 parents and analyzed the data thematically.Results Two main themes were developed. The first theme, ‘adopting a position on HRT’, involved seeking information and evaluating it for lived experience (by the youth) and local and family relevance (primarily parents) and deliberating around three considerations, namely infertility risk (youth and parents), possibility of detransitioning (youth and parents), and youth’s decision-making capacity (mostly parents). The second theme, ‘reaching an agreement or not’ unfolded through parental approval, parent–youth compromise, or parental refusal. Compromise included trying Traditional Chinese Medicine first. Parental refusals were driven by religious beliefs and fear of youth’s impulsivity. In response, some youth reported pressuring parents to agree to HRT.Discussion Findings are discussed in the context of Asian values—particularly filial piety, hierarchical family roles, and patrilineal obligations—and how these steer conversations and outcomes. Infertility concerns often reflect intergenerational expectations around family lineage. The possibility of detransitioning may be linked to efforts to safeguard family reputation. Youth pressure on parents to give consent can reflect acute distress following limited options in the Singaporean context. Compromise softened hierarchical expectations and opened space for youth participation. Findings highlight that research on the experience of youth and family can be enriched by considering experiences and settings beyond the ones discussed in the Western-focused literature.