China’s Ministry of Health has published new proposed clinical guidelines on gender reassignment surgery.

According to the Ministry of Health website, those wishing to undergo surgery must have no criminal record, be single, over 20 years old and have lived as their desired gender for at least two years.

The website also states that candidates for gender reassignment surgery must have a year of psychotherapy and will have to change the sex on their identity cards before having surgery.

It is estimated that up to 400,000 people in China are considering gender reassignment, with at least 1,000 people having already having undergone surgery. However, gender reassignment is still considered something of a ‘hidden’ issue.

Qiu Renzong, bioethicist at the Chinese Academy of Social Sciences told the China Daily, “Transsexuals who might consider sex change remain largely hidden in China’s mainstream social life. It’s hard for them to live and work openly in the gender role they want.”

The guidelines are an attempt to tighten regulations concerning gender reassignment surgery, for both candidates and doctors.

Doctors carrying out gender reassignment surgery will be more strictly regulated and those who perform a full operation must have already completed a minimum of ten cases of sexual organ reconstruction.

They will also be told to explain alternative options to potential candidates, such as hormone therapy, before beginning the surgical process.

If the guidelines are accepted, doctors hope that access to gender reassignment surgery will become not only safer, but more publicly accepted.

“As long as a person meets the physical and mental requirements, she or he should be granted the permit to have the surgery,” Renzong said.

He added that the no criminal convictions rule was in the interests of “public security”.

However, he criticised the requirement for candidates to to live openly in their desired gender, saying it could be hard for them to live and work.

Ministry officials have not commented on the publication of the guidelines. Health professionals have until July 10th to comment on them.