Being trans in Korea: key milestones and stigmatization across life stages in a nationwide survey of 585 transgender and non-binary young adults

Transgender identities

Participants’ gender identities and demographic characteristics were collected in Wave 1. Using the 2-step process [17], participants could be categorized based on their sex assigned at birth as well as their current gender identity. Combining responses to sex assigned at birth and gender identity (man, woman, or non-binary), participants could be grouped into 4 categories: trans men, trans women, non-binary assigned female at birth (AFAB), and non-binary AMAB. Given the cisnormative culture of Korean society, which labels and socializes individuals based on the sex assigned at birth, categories identifying TGNB individuals’ gender identities on a spectrum relative to their sex assigned at birth were also utilized. These categories include transmasculine (i.e., AFAB individuals identifying on the masculine spectrum) and transfeminine (i.e., AMAB individuals identifying on the feminine spectrum). These 2 categorization systems, differing in their consideration of non-binary identities, were associated with distinct experiences among TGNB individuals.

Socio-demographic characteristics

In addition to transgender identity, the following socio-demographic characteristics were assessed in Wave 1: sexual orientation, age, highest level of education attained, employment status, monthly income, and region. Participants were also asked about their method of accessing the survey link (i.e., data collection channel) in Wave 1.

Transgender identity developmental milestones

We adapted a measure of developmental milestones specific to TGNB individuals from Tatum et al. [6] and incorporated it for Wave 2. Participants reported the ages at which they: (1) first thought they were transgender (regardless of their knowledge of the term “transgender”); (2) accepted their transgender identity (again, regardless of knowledge of the specific term); and (3) first came out to others as transgender. Ages for these developmental milestones were analyzed continuously.

Experiences of anti-transgender stigma across different settings

Experiences of anti-transgender stigma throughout the life course of TGNB individuals were measured at Wave 1. The survey investigated stigma stemming from policies, environments, and interactions with others in secondary schools, the military, and job application processes. For each setting, specific items were asked of participants who reported having attended secondary schools (n=579), AMAB participants who were serving or had completed mandatory military service (n=107), and participants who had applied for jobs in the past 5 years (n=467).

Regarding secondary school experiences, participants were asked about difficulties with sex-segregated physical environments (e.g., single-sex schools, single-sex classes, and single-sex dormitory assignments) and policies (e.g. wearing gendered uniforms), as well as anti-transgender victimization by teachers.

For mandatory military service experiences, participants responded to 2 items addressing difficulties (e.g., using communal showers and fear of being outed) and discriminatory practices (e.g., classification as maladjusted soldiers and referral to “Green Camp,” a specialized training program designed for soldiers facing adjustment challenges) related to their transgender identity.

In terms of job search experiences, participants initially answered a yes/no question about whether they had given up applying for a job due to their transgender identity. They were subsequently asked about other difficulties experienced by TGNB individuals during the job application process, including the cancellation or refusal of job offers. Participants were asked to select all applicable responses for items within each setting of experiences of anti-transgender stigma, resulting in mutually inclusive answers.

Use of gender-affirming medical interventions and reasons for non-use

Additionally, the survey explored participants’ experiences with seeking and receiving gender-affirming medical intervention (GAMI) and reasons for not receiving such intervention at Wave 1, informed by prior research indicating that barriers to GAMI represent a key form of structural stigma for transgender Koreans [12]. GAMI was considered to include the psychiatric diagnoses required to access further GAMI, hormone treatment, and gender-affirming surgery. Participants who had not used GAMI were asked to select all relevant reasons for non-use, and the analysis included the 3 most frequently endorsed reasons of non-use for each type of intervention.

Statistical analysis

Frequencies and proportions were calculated for participant characteristics and experiences of anti-transgender stigma across transgender identity categories. These categories were applied based on the significance of social experiences influenced by sex assigned at birth and the role of non-binary identity. Socio-demographic characteristics, experiences of stigma in secondary schools, and experiences of stigma during the job search process were reported using transfeminine/transmasculine categorizations, given that these characteristics were considered to be primarily affected by social experiences related to one’s sex assigned at birth. Analyses of transgender identity development, experiences of stigma in the military, and use of GAMI employed gender categorizations that distinguished non-binary participants, because being non-binary as opposed to binary transgender (i.e., trans women and trans men) was likely influential in gender identity development, gender socialization, and preferences regarding GAMI use.

Mean ages at milestones for transgender identity development were compared across all 4 identity categories using analysis of variance (ANOVA). Bonferroni post hoc analyses were performed following one-way ANOVA to assess pairwise differences for each milestone among the 4 transgender identity groups. The chi-square test was conducted for all other variables to compare frequencies across transgender identity categories, alongside descriptive analyses. For mutually inclusive responses, the chi-square test was conducted separately for each response. All analyses were performed using Stata/MP version 16.0 (StataCorp., College Station, TX, USA).

Policy implications for the secondary education system

Schools play a crucial role in gender socialization, as children and adolescents interact with teachers and peers who inform their understanding of gender norms and shape their gender expectations [21,22]. Research indicates that TGNB individuals often recognize their gender identity during childhood [23,24] and face victimization and bullying from peers at school [11,25], which contribute to adverse mental health outcomes, including depression and suicidality [11,25]. Our findings align with previous research. The average ages at which transgender identity developmental milestones occur suggest that the period between awareness and acceptance of one’s transgender identity typically coincided with adolescence. Given the critical role of secondary schools for Korean adolescents, policy interventions targeting the secondary education system are fundamental to fostering healthy gender socialization and development among TGNB students in Korea. Our documentation of transgender identity-related victimization experienced by TGNB individuals further underscores the urgent need for inclusive school environments.

A key area requiring improvement and intervention in schools is the practice of sex segregation, underscored by the present findings on hardships faced by TGNB individuals in secondary education settings. Our results indicate that anti-transgender stigma is institutionalized within the Korean secondary school system, especially through single-gender institutions, sex-segregated facilities, and the use of gender-specific uniforms. Studies of TGNB youths in United States secondary schools found that restrictions on restroom and locker room use based on birth-assigned sex were associated with increased prevalence of depression and suicidality [26] and greater likelihood of sexual assault [27]. These findings emphasize the importance of ensuring unrestricted access to sex-segregated facilities for TGNB students, providing gender-neutral options for these facilities, and eliminating discrimination and violence against these students, especially those perpetrated by teachers.

Policies addressing anti-transgender discrimination in schools are also necessary. As of 2023, seven cities and provinces had implemented student human rights ordinances, 5 of which explicitly included sexual orientation and gender identity as protected categories [28]. However, students remained largely unaware of ordinance content, indicating inadequate human rights education in the schools [28]. Coupled with the frequent experiences of anti-transgender stigma reported in the current study, these findings stress the need for increased regional-level and school-level efforts to inspect and monitor adherence to the ordinances. Notably, the reach of these policies and practices remains limited to their specific provincial and institutional contexts. Ideally, these localized efforts should serve to complement national anti-discrimination laws and policies, which are still absent in Korea [10,29].

In conjunction with these policy-level efforts, human rights values can also be incorporated into school curricula, empowering teachers and school leaders to actively create safer environments for TGNB students. Formal curricula may be revised to include age-appropriate content on sexuality and gender diversity, supplemented by informal educational materials [30]. Schools can also provide comprehensive sex education to students, equipping them with knowledge and sensitivity regarding social and health issues related to sex, sexuality, and gender [31] and thus enhancing overall student well-being [32]. Although existing studies were not specific to transgender-focused curriculum materials and TGNB students, their results suggest that interventions aimed at minority student groups can benefit the broader student population.

Policy implications for the military

Upon graduation from secondary school, Korean AMAB young adults encounter yet another societal structure built upon patriarchal gender roles and expectations—the military. The Korean military comprises both career soldiers, who are volunteers, and conscripts, who fulfill 2-year mandatory military service required of all able-bodied men between 19 years and 35 years old [33]. While a legal gender change to female can exempt individuals from mandatory service, financial and social barriers often prevent the completion of medical transition and subsequent legal gender recognition by early adulthood [33]. Consequently, many Korean trans women and non-binary AMAB individuals have no choice but to be conscripted after graduating from high school. Given that military service coincides with formative periods in transgender identity development, serving in the military poses unique challenges for Korean trans women and non-binary AMAB individuals.

Our study revealed prevalent reports of experiences related to anti-transgender stigma in the military among trans women and non-binary AMAB individuals. Even in the United States, a country with an all-volunteer force, 93% of transgender soldiers reported bullying and stigma related to their gender identity [34]. The same study indicated that experiences of stigmatization in the military were associated with poor mental health [34]. Additionally, sexual violence has been found to exacerbate mental health issues among sexual and gender minority service members [35]. In Korea, the magnitude of this association may be even greater due to the conscription system, which can force individuals into military service against their will.

The discharge of an openly transgender serviceperson while simultaneously conscripting other TGNB individuals, often against their wishes, highlights an ironic double standard in the Korean military. Moreover, our results showed that TGNB soldiers were often labeled as maladjusted, flagging them for extra attention from officers, with some even being sent to camps for adjustment issues. Although these military policies and practices were intended to be protective, being labeled as maladjusted was inherently stigmatizing. This stigma was intensified by the transgender-specific challenges faced by soldiers in a male-dominated environment during mandatory military service.

The Korean military must acknowledge the transphobia embedded in its policies and culture, recognize it as an occupational hazard for the health of transgender servicepersons, and work towards eradicating anti-transgender stigma and discrimination [36]. Additionally, the exemption criteria in military physical exams used for conscription should be amended to accommodate the realities of TGNB young adults who have not undergone GAMI due to systematic barriers in Korean society.

Policy implications for equitable hiring practices

Work is an essential component of life, providing key opportunities to accumulate financial and social resources. However, TGNB individuals in Korea frequently face employment barriers rooted in cisnormative workplace cultures [37]. Research from other countries, primarily the United States, has demonstrated that transgender identity can obstruct individuals from securing interviews or job offers, contributing to high unemployment rates within transgender populations [16,37]. Our findings highlight the employment challenges faced by Korean TGNB individuals, consistent with a systematic review of the international literature that reported that transgender employees frequently experience discrimination, harassment, and stigma [15].

Korean TGNB individuals encounter barriers even before entering the workforce. Many reported discontinuing the process of job search and application out of fear that their gender identity or gender recognition history would be disclosed against their will. Additionally, they experienced difficulties stemming from discordance between their legal gender status and their gender expression, which may be attributed to the lack of transgender visibility and rigid patriarchal gender norms within Korean society. Furthermore, some were entirely barred from workforce entry through denial of job offers based on their transgender identity.

Although the Equal Employment Opportunity and Work-Family Balance Assistance Act and the Labor Standards Act prohibit workplace and hiring discrimination based on sex, these laws provide limited protection for TGNB individuals. Strict measures restricting employers’ access to personal information, including education history and legal gender change, are necessary. To address gaps in existing anti-discrimination policies, the enactment of a comprehensive anti-discrimination law explicitly inclusive of gender identity has been suggested [10,29]. Such legislation should clearly define and prohibit discrimination throughout employment, from hiring to termination. Additionally, enacting a legal gender recognition law that allows TGNB individuals to align their legal gender markers with their current gender identity and presentation, along with provisions protecting their gender recognition history during the hiring process, could provide greater safety for TGNB job seekers [19].

Policy implications for inclusive healthcare services

GAMI, which helps align TGNB individuals’ physical characteristics with their gender identity [38], is a prerequisite for legal gender recognition in Korea. Thus, it is crucial for TGNB individuals who desire to undergo legal transition. While international trends are increasingly minimizing psychiatric requirements and depathologizing transgender identities [38,39], Korean TGNB individuals are still required to undergo psychiatric evaluation before accessing GAMI, resulting in additional costs and delays in treatment. Moreover, despite Korea’s advanced medical infrastructure, accessing GAMI is complicated and expensive because it is not covered by the nation’s universal healthcare system [40,41]. Out-of-pocket expenses for these surgical procedures range from 1 million to 60 million Korean Won (approximately 714 to 42,823 US dollar, as of 2025) [42]. These estimates do not account for living expenses during recovery or the overseas travel costs incurred by individuals who opt for surgery abroad due to a lack of qualified healthcare professionals capable of performing gender-affirming surgery in Korea [42].

Our findings confirm that the cost of GAMI represents the primary barrier preventing TGNB individuals from accessing these essential medical interventions, which may be key to leading their authentic lives as transgender individuals. Results from this study indicate that over 70% of participants did not undergo gender-affirming surgery due to financial constraints. This aligns with findings from other countries, including the United States, Canada, Australia, and the United Kingdom [43,44]. Systematic reviews consistently identify financial costs as one of the main barriers to accessing gender-affirming healthcare services [43,44]. Furthermore, a United States study found that income disparities among TGNB patients impact not only whether they undergo gender-affirming surgery but also how early in life they access these services, often relying on private insurance [45]. Korean TGNB individuals likely face similar challenges. Although transgender identity often develops during adolescence and early adulthood, individuals are unlikely to independently amass sufficient financial resources to afford GAMI by their early 20s or even later, especially given the structural exclusion of TGNB individuals from the job market, as discussed previously.

Findings from our study and prior research highlight the urgent importance of addressing the unmet healthcare needs of TGNB individuals resulting from socioeconomic disparities. One potential intervention discussed in the literature is improving coverage of GAMI through private insurance, particularly as many studies originate from the United States [43]. However, in Korea—a country with a universal healthcare system—relying on private insurance coverage could exacerbate income disparities in accessing GAMI. Therefore, coverage should instead be expanded through the National Health Insurance Service to include gender-affirming healthcare services [40]. Additionally, establishing grants and social loan programs at the regional and community levels is recommended to further support TGNB individuals financially, promoting equitable access to necessary healthcare services.

TGNB Koreans face significant challenges not only due to a lack of affordable GAMI but also because of legal misrepresentation and limited financial and social resources [40,46]. Currently, only 1 medical school in Korea offers regular courses specifically addressing LGBTQ health. This gap underscores the need for more inclusive medical education to improve the knowledge, attitudes, and comfort levels of healthcare professionals in treating LGBTQ patients [47]. To address these issues, we recommend increased investments in training healthcare professionals to become competent GAMI providers and creating inclusive healthcare environments for TGNB patients. This includes providing gender-neutral identification options, inclusive administrative paperwork, and accessible physical spaces [48].

Overall implications for Korean society

Despite the pervasive anti-transgender stigma documented across multiple social settings in this study, protective measures against transphobic discrimination and victimization in Korea are notably absent at both national and institutional levels. The consistent exposure to anti-transgender stigma across various sectors suggests that such stigma is deeply embedded within Korean society. The systemic nature of this discrimination indicates that policy implications identified for specific settings may have broader applicability throughout Korean society. We recommend developing comprehensive guidelines for gender diversity, implementing cultural competency training tailored to specific environments, and establishing anti-discrimination laws and policies that explicitly protect gender identity and expression at both national and setting-specific levels [29].

Furthermore, legislation of gender recognition laws [19] and comprehensive anti-discrimination law [10,20] are urgently required to ensure that TGNB individuals can align their legal gender status with their gender identity and experience protection from transphobic discrimination. Upon implementation of the suggested trans-inclusive policies and practices, future studies should investigate their impact on the lived experiences of TGNB individuals in Korea and provide comparative analyses with other countries to examine transgender inclusion within Korean society.