Only surgeons with more than five years' experience or training in sex change operations will be permitted to perform the procedures.

"Stringent criteria will protect the interests of both patient and surgeon," said Chen, who completed almost 200 sex swap operations between 1990 and 2003. "There is a story behind almost each stipulation. Candidates must prove a five-year desire to stop them regretting their transition later.

"International studies show people can live to regret the change, with some even going so far as to have the surgery reversed and return to their original gender. Parts of the surgery are irreversible, so it should be considered rationally. And that takes time."

He said getting consent from parents could also prevent the harassment faced by surgeons from family members unhappy at their relative's sex switch.

Psychology, before and after the operation, plays a massive part in the sex change process, with opinions often split over whether transgender candidates are really "born in the wrong body" or are suffering from some kind of mental illness.

The reasons behind feelings of mind-body incompatibility remain unclear, but experts say transsexuals can turn to self-harm or even suicide if they cannot find a way to live as the opposite sex.

"Transsexuals are not freaks. We are born this way. Only through a sex change operation can we be saved and become the people we really are," said Yang.

But Zhai Xiaomei, a bioethicist at the Peking Union Medical College in Beijing, disagreed and warned: "Surgery should be a last resort. Doctors should tell patients about other options first, such as hormone therapy.

"They should also explain to patients about the risks of the operation and the underlying social barriers after it, such as employment discrimination, and administrative recognition and approval."

Under the proposed rules candidates will have to undergo at least one year of "successful" psychological therapy before they get the go-ahead, potentially posing another financial headache.

The average cost of a sex change operation is already around 50,000 yuan, not including any extra plastic surgery or facial remolding. But the average wage for those Chinese living in urban areas was just 16,943 yuan last year, according to government figures, while for rural residents it was just 6,481 yuan.

Han said her sex change was not covered by her medical insurance, adding there is also no avenue for a transsexuals to borrow money from a bank or charity fund.

"Many transsexuals, like myself, have to work in she-male shows to make enough money quickly for the expensive surgery," she said.

Despite praise for the draft guidelines, Chen said there was still much room for improvement as they only address the physical side of the sexual transition and fail to take on the problem of discrimination.

"Even though transsexuals are the absolute minority in society, their rights and interests should not be neglected," said Chen, who stopped performing gender reassignment surgery because of the high legal risks and the fact most of his patients went on to live "such miserable lives". He now trains other surgeons in the field.

"What's the point of the surgery if the lives of the patients become even worse after it? It's too painful to watch them live miserable lives and not be able to do anything."

To make sure his patients were able to find jobs, he said he set his own "unreasonable criteria" for candidates: Men had to have a college degree, while women had to prove they would be able to earn a living after the surgery.

"Many people, including transsexuals, criticized me for such criteria. But I had no discrimination against anyone, my sole purpose was to make sure that they would be able to get a job and live a normal life afterwards," he said. "Compared with medical problems, post-operation support to transsexuals is equally important. Only when a transsexual enjoys equal rights and is accepted by the society, can we say his or her surgery is successful."

Han agreed and said the rules, if not improved before implementation, will make little impact.

"I talked with some of my sisters (people who have undergone male-to-female operations) about the guideline. Their reaction was, 'Does it matter?' I don't think the draft can help solve our practical problems, like discrimination and employment difficulties," she said.

China has no laws stipulating the new gender of a transsexual should be recognized, but the Ministry of Health has asked local public security bureaus to change the ID cards of patients if they can provide the necessary medical documents.

"We are lucky compared with transsexuals in other countries where gender on ID cards is based on birth certificates," said Han. "But a new ID card does not mean we are accepted. Compared to deciding to go ahead with the operation, being accepted by society is far more difficult."

Han, a former teacher at a dance school in Beijing, was fired shortly after her father learned she was a post-op transsexual. He complained to her boss, who was unaware of her past. "They were worried I might be a bad influence on the kids," she said.

She revealed that about 80 percent of Chinese transsexuals are forced to turn to she-male shows or even prostitution in order to make a living, adding: "Finding a decent job is almost impossible." In 2001, Han studied clothes design and now runs her own fashion studio.

Xinhua contributed to the story

(China Daily July 16, 2009)