Abstract

Over the last four decades, public language for gender transition, transgender identity, and gender diversity in mainland China has accumulated through several institutional channels. State newspapers since the 1980s placed gender nonconformity within medical, social, and governance frames. In the 1990s, bianxing ren (变性人, literally a person who has “changed sex”) became highly visible through surgery-centered profiles and celebrity narratives. In the 2000s, household-registration and medical regulations connected terms such as bianxing shoushu (变性手术, “sex-change surgery”) and yixingpi bing (易性癖病, a historical clinical label) to executable procedures. During the 2010s, kuaxingbie (跨性别, transgender) became a core umbrella term in research, advocacy, surveys, and community services. Yet clinical sites continued to use yixingzheng (易性症), the 2022 national restricted-medical-technology rules adopted xingbie chongzhi jishu (性别重置技术, gender reassignment technology), and Chinese-speaking communities developed relational and pathway terms such as kuar (跨儿), FTM/MTF/FTX, and MtX. These vocabularies now coexist because the institutions that use them change at different speeds.

This essay proposes a vocabulary stratigraphy model with four interconnected naming regimes: the clinical-diagnostic layer, media-personhood layer, administrative-procedural layer, and community-service layer. Each layer has characteristic speakers, purposes, archival traces, and revision cycles. The first appearance of a term therefore marks only one kind of historical event. Entry into national newspapers, hospital clinics, police procedures, national surveys, or community hotlines represents different forms of institutionalization.

To make those differences reproducible, the essay uses a historical “term card” with eight fields: term_form, speaker, referent, institutional_function, event_time, record_time, self_or_external_label, and later_gloss. The method preserves period vocabulary while making the standpoint of present-day interpretation explicit. It also makes new archival discoveries easy to insert into a layered historical sequence.

Keywords: transgender; bianxing ren; yixingzheng; gender reassignment; kuar; mainland China; public language; medical history; media history

1. The historical problem: one person can pass through several vocabularies

A history of transgender language in mainland China quickly encounters terms that appear to compete with one another. Newspapers in the late twentieth century often used bianxing ren. Clinical sources have used yixingpi, yixingzheng, and related diagnostic language. The 2009 Ministry of Health regulation centered bianxing shoushu and referred to patients through the then-current clinical label yixingpi bing. By 2016, UNDP’s national survey used transgender as a stable population category. In 2018, Peking University Third Hospital still titled a clinic page “Comprehensive Treatment Clinic for Yixingzheng.” In 2022, the national restricted-medical-technology rules used gender reassignment technology. Community organizations, meanwhile, placed transgender and kuar into hotline, psychological-support, parent-support, and survey interfaces (Ministry of Health 2009; Peking University Third Hospital 2018; UNDP 2016, 2018; National Health Commission 2022).

The differences are institutional. A clinician needs a term that can enter a chart, specialty clinic, assessment process, and treatment pathway. A newspaper editor needs a category that allows a reader to recognize the subject of a profile quickly. Police and health administrators need procedural terms that connect identity fields, hospital certificates, technical qualifications, and review conditions. Community workers need language that can organize mutual aid, surveys, family communication, and self-identification. Those goals generate distinct naming practices and distinct clocks of change.

Xiaogao Zhou and Songyin Liu’s content analysis of 154 state-run newspaper articles from 1980 through 2021 provides a particularly useful scale for this history. They show how gender nonconformity became legible to institutions through medicalized and socialization explanations and through governance frames spanning medicine, education, criminal justice, marriage, and media (Zhou & Liu 2023). Howard Chiang’s history of modern Chinese sex science places changing categories of sex and transsexuality within a longer transformation of knowledge about the body (Chiang 2018). Read together, these works shift the central question from “Which term came first?” to “Which institution used which term, at what moment, to accomplish which kind of work?”

This essay therefore reconstructs the period 1980–2025 through four naming regimes. The metaphor of a “layer” is geological: new terms cover, translate, and connect older terms, while older layers can remain active in hospital pages, archived regulations, media databases, and personal memories. A reader in 2025 can encounter transgender, yixingzheng, bianxing shoushu, gender reassignment, and kuar on the same day. Historical reading requires the date and institutional location attached to each word.

2. Sources and method: putting term form, speaker, and institutional function on one card

The evidence comes from three groups of sources. The first is scholarship on Chinese sex science, queer and transgender studies, media discourse, social organizations, and transgender health. Works by Chiang, Hongwei Bao, Jia Tan, and Lisa Rofel provide long-run intellectual, media, and movement contexts. Newspaper studies by Zhou and Liu, Ke Zhang and colleagues, and Zhang and Zhuang provide systematic evidence for public representation. Health research shows how “transgender” became a stable research-population category in the 2010s (Chiang 2012, 2018, 2021; Bao 2018, 2021; Tan 2023; Rofel 2007; Zhang et al. 2016; Chen et al. 2019, 2020).

The second group consists of institutional texts: health regulations, hospital pages, household-registration procedures, UNDP reports, national surveys, and service pages. These sources are especially valuable when the historical question concerns entry into an institution. The 2009 Technical Management Standard for Sex-Change Surgery (Trial) writes bianxing shoushu and yixingpi bing into medical-technology governance. The 2022 national standard uses gender reassignment technology, giving a precisely datable change in administrative-medical wording (Ministry of Health 2009; National Health Commission 2022).

The third group consists of news, archives, and community preservation. A 2007 Southern Weekly retrospective on Qin Huiying explicitly points back to a front-page item on the second page of Wenhui Bao on 31 August 1990, “Professor Performs Ingenious Operation, Bearded Man Becomes Young Woman,” and identifies Qin as the first transgender person publicly reported by Chinese media in that source’s framing (Southern Weekly 2007). This retrospective carries two clocks: the date of the original event and the date of the surviving later record. Digital projects such as the Chinese Transgender Digital Archive, the Transgender News Archive, and the Sinophone Transgender Chronicle similarly bring dispersed organizational pages and news texts back into searchable history.

For major naming evidence, this essay uses an eight-field term card:

  1. term_form: the exact form preserved in the source;
  2. speaker: hospital, government body, newspaper, scholar, community organization, or individual;
  3. referent: the person, diagnosis, technology, identity, or service population to which the term points;
  4. institutional_function: diagnosis, news storytelling, registration, medical regulation, survey sampling, mutual aid, and so on;
  5. event_time: when the described event occurred;
  6. record_time: when the surviving source was created or published;
  7. self_or_external_label: whether the wording is self-description, an institutional label, a media label, or an analyst’s term;
  8. later_gloss: the present-day explanation supplied for historical readers.

This structure keeps period language visible while separating it from the historian’s contemporary vocabulary. It also prevents a common archival error: treating a term that is searchable today as evidence that it had the same reach at the time of the event.

3. Layer one: medicalization and media personhood in the 1980s and 1990s

The 1980s are an important starting point for the renewed large-scale public visibility of gender nonconformity in reform-era China. Zhou and Liu begin their state-newspaper corpus in 1980 and show that reporting frequently organized gender-nonconforming lives through medical knowledge, socialization, family order, education, and governance (Zhou & Liu 2023). Ke Zhang and colleagues, working with later English-language Chinese news, find a continuing mixture of health, victimhood, and progress narratives, while Zhang and Zhuang show how photographs cast sexual minorities into recognizable social roles such as victims, concealers, activists, and elites (Zhang et al. 2023; Zhang & Zhuang 2023/2025).

Within this media environment, bianxing was unusually suited to person-centered journalism. It is eventful language: sex or gender is presented as having “changed,” and the story can therefore be organized around before and after—surgery, name, clothing, marriage, occupation, identity papers, and public reaction. Qin Huiying’s 1990 publicity is a clear example. The 2007 Southern Weekly retrospective traced the story to the 31 August 1990 Wenhui Bao report and called Qin “the first transgender person publicly reported by Chinese media” in its retrospective vocabulary. Jin Xing’s 1995 surgery and subsequent documentary, autobiography, interviews, and television career gave the public another durable narrative in which bianxing was repeatedly attached to a famous person (Southern Weekly 2007; China News Service 2011).

The media durability of bianxing ren came from this narrative compression. A complicated history of identity, embodiment, healthcare, work, family, and social recognition could be rendered as the biography of “a person who changed sex.” Fang Gang’s 1996 book The Phenomenon of China’s ‘Bianxing Ren’ shows that by the mid-1990s the expression itself could organize a book-length public discussion (Fang 1996).

This media layer interacted closely with clinical language. Reports regularly cited psychiatrists, plastic surgeons, psychologists, diagnoses, and “patient” categories; medical institutions in turn used public cases to explain diagnosis and surgery. Clinical authority gave journalists a framework of explanation, while visible personalities gave medical categories a public social referent. The loop resembles the process Zhou and Liu describe: gender nonconformity becomes visible as an individual characteristic and as a domain that institutions can explain and regulate (Zhou & Liu 2023).

Within vocabulary stratigraphy, bianxing ren is therefore best understood as a characteristic term of the media-personhood layer. Its historical value lies in showing how a period rendered gender transition reportable. When the term is preserved today, the term card should also preserve its speaker, date, and genre. That allows the historical record and present-day self-identification language to be read together while keeping their functions distinct.

4. Layer two: clinical-diagnostic language enters clinics, charts, and eligibility pathways

Clinical language runs on another clock. Chiang’s After Eunuchs traces a long modern Chinese genealogy of sexual knowledge and shows how scientific and biomedical ways of understanding sex, sexuality, and the body developed across the twentieth century (Chiang 2018). Within reform-era psychiatry and surgery, terms such as yixingpi and later yixingzheng became ways of connecting diagnosis, psychological assessment, plastic surgery, and treatment eligibility.

The Ministry of Health’s 2009 standard is an unusually sharp institutional cross-section. The title uses bianxing shoushu (“sex-change surgery”), while the body defines the target patient through the then-current diagnosis yixingpi bing and establishes conditions concerning hospital level, surgeon qualifications, age, marital status, diagnostic certificates, and preoperative documentation (Ministry of Health 2009). Contemporary news reports repeated the same wording, carrying clinical and regulatory terminology into mass circulation (China National Radio 2009; China News Service 2009).

A Peking University Third Hospital page from 2018 provides another temporal marker. Its title is “Comprehensive Treatment Clinic for Yixingzheng,” and its text uses a cluster of clinical phrases concerning gender recognition, yixingpi, and yixingzheng while describing consultation and treatment (Peking University Third Hospital 2018). At the same moment, UNDP reports, Beijing LGBT Center research, and academic publications were already using transgender as an umbrella population and identity term. Clinical institutions and community/research institutions were therefore moving on different naming cycles: clinics updated language through diagnostic systems, professional traditions, and service administration, while advocacy and research networks updated language through identity politics, international exchange, and service practice.

The 2022 national restricted-technology rules mark another shift. The regulatory heading uses xingbie chongzhi jishu, “gender reassignment technology,” in place of the 2009 title’s “sex-change surgery” wording (National Health Commission 2022). By then transgender was firmly established across community and research settings. “Gender reassignment” in the national standard performs a narrower technical-regulatory function. That functional distinction is historically more informative than arranging the two terms on a simple old-to-new ladder.

The clinical layer matters because diagnosis creates interfaces. A diagnostic term can affect clinic routing, certificates, surgery pathways, psychological assessment, and medical records even when the word has relatively low visibility in general media. A history of terminology should therefore record clinical words together with the concrete institutional actions to which they were attached.

5. Layer three: administrative-procedural language connects sex/gender to certificates, registration, and regulation

Administrative language gives terms meaning through procedure. A 2002 reply from the Third Bureau of the Ministry of Public Security concerning changes to the sex field in household registration after surgery connected bianxing shoushu, the “sex item” in household registration, hospital certification, police review, and identity-number reissuance into an executable chain. The surviving text states that an applicant who produced proof of successful surgery from a designated hospital could, after public-security review, change the registered sex item and receive a newly compiled citizen identity number (MPS Third Bureau 2002).

This is a different use of bianxing from the media biography. Administrative documents focus on proof types, reviewing authorities, field changes, and subsequent identity documents. News coverage in 2002 connected the two worlds again by explaining to a wider public how people described as bianxing ren could alter identity-document sex fields. The procedural vocabulary thus acquired social visibility outside the bureau that administered it.

The 2009 health standard connected another cluster of actions to bianxing shoushu: qualifications of institutions and physicians, diagnosis, certificates, age, marital status, and technical access (Ministry of Health 2009). UNDP’s 2018 Legal Gender Recognition in China then gathered laws, regulations, rulings, policies, and community experience under a rights-oriented framework and consistently described the affected population as transgender people (UNDP 2018). The same administrative terrain could now be described through several vocabularies: “household-registration sex change after surgery,” “legal gender recognition,” and “transgender inclusion.”

The administrative layer demonstrates that the institutional meaning of a term comes from the action it triggers. “Sex/gender” can be a household-registration field; “gender reassignment” can be a regulated medical technology; “legal gender recognition” can be a broader relationship between identity and access to public services. Extracting only the keyword loses these action chains. For this reason, institutional_function is a central field in the historical term card.

6. Layer four: “transgender” enters research, surveys, and service networks in the 2010s

During the 2010s, transgender / kuaxingbie gained new institutional density. Howard Chiang’s edited volume Transgender China in 2012 made transgender studies in Chinese and Sinophone contexts an explicit academic object; After Eunuchs and Transtopia in the Sinophone Pacific expanded the historical frame (Chiang 2012, 2018, 2021). Hongwei Bao’s work on tongzhi activism and queer media and Jia Tan’s study of digital feminist and queer media placed identity language within changing movement and platform infrastructures (Bao 2018, 2021; Tan 2023).

Large surveys were another route of institutionalization. The 2016 national survey jointly implemented by UNDP, Peking University’s Sociology Department, and Beijing LGBT Center explicitly included gender identity and gender expression and incorporated transgender people into its LGBTI population categories. Nearly 30,000 valid questionnaires gave that classification a place in national-scale data infrastructure (UNDP 2016). The Chinese Trans Health Blueprint likewise described trans people as the population for evidence-based health services and linked government, civil society, medical professionals, and community knowledge (UNDP 2016/2018). The 2017 national survey of transgender and gender-nonconforming people further established “the transgender population” as a distinct quantitative research object (Beijing LGBT Center et al. 2017).

Health research reinforced the change. Zhang and colleagues’ 2016 nationwide online study treated transgender people as the study population. Chen and colleagues’ national studies examined hormone and surgery needs and suicidal ideation using transgender as a stable research category (Zhang et al. 2016; Chen et al. 2019, 2020). An important implication is that transgender could encompass people at many points in relation to medical transition: people who had undergone procedures, people seeking them, people pursuing different forms of embodiment, and people whose identities remain independent of surgery.

Service networks brought the term into everyday interfaces. China’s national transgender hotline launched in 2018; later Hotline 2.0, the Kuar Psychological Support Group, parent groups, health surveys, and medical-referral work placed transgender and kuar into contact points for help (China Development Brief 2018; Kuar Psychological Support Group 2022). In these settings a term has a practical service function: it helps callers, parents, counselors, clinicians, and volunteers recognize whether a resource is meant for them.

Kuar is especially revealing as a relational name. The word connects the translation history of “trans,” Chinese affectionate word formation, and community mutual aid. It appears in psychological services, parent communication, and public education with a different affective register from formal kuaxingbie. The two overlap, but they do different kinds of social work. Community vocabulary is consequently more granular than administrative classification and more dependent on platform, generation, relationship, and self-selection.

7. Four layers at once: the vocabulary stratigraphy of 2018–2025

The year 2018 is an excellent cross-section. Peking University Third Hospital published its yixingzheng clinic page. UNDP released Legal Gender Recognition in China using transgender language. The national transgender hotline appeared within a civil-society service network. General-interest media continued to rely heavily on bianxing ren and bianxing shoushu when explaining personalities and medical stories (Peking University Third Hospital 2018; UNDP 2018; China Development Brief 2018). One person moving among institutions could therefore encounter four vocabularies in a short period of time.

After 2022, the stratigraphy is even clearer. National medical-technology administration uses “gender reassignment technology.” Hospitals, research papers, and service teams continue to use clinical terms or transgender according to context. Community platforms also employ FTM, MTF, FTX, MtX, and other abbreviations to describe direction, embodiment plans, or identity positions. Kuar remains visible in family and psychological-support contexts. Each term carries a coordinate: who is speaking, to whom, and for what institutional purpose.

That is the core of the vocabulary-stratigraphy model. The four layers can be represented as:

clinical-diagnostic layer → media-personhood layer → administrative-procedural layer → community-service layer

The arrows indicate borrowing and translation, while each layer retains its own internal clock. Media quote doctors. Administrative rules require hospital certificates. Community reports investigate administrative barriers. Clinics update terminology as research and diagnostic frameworks change. Meaning contracts or expands when a term travels from one layer to another.

Bianxing ren has strong narrative force in person-centered media. Yixingzheng has a diagnostic-interface function within a period of clinical practice. Gender reassignment technology has a regulatory-technical function in the 2022 national standard. Transgender has an umbrella classification function in surveys, research, and advocacy. Kuar has a relational and mutual-aid function in parts of the Chinese-speaking community and family-service environment. Putting these functions on one historical map explains coexistence more effectively than declaring one word to have replaced all the others.

8. Three speeds behind lexical change

Vocabulary stratigraphy also reveals three speeds. The first is the speed of institutional revision. Regulations and clinic names are shaped by formal procedures, professional systems, and document cycles. The 2009 and 2022 national medical standards therefore function as unusually precise chronological anchors.

The second is the speed of media circulation. Media terminology can spread rapidly through celebrities, documentaries, court cases, policy news, and platform events. Bianxing ren gained high public visibility through surgery-centered profiles in the 1990s, and Jin Xing’s long public career kept transition vocabulary visible across entertainment media. Media also adopted transgender, allowing an older person-centered term and a newer umbrella identity term to coexist in search and reporting.

The third is the speed of community innovation. Community terms can arise quickly in a small network and circulate through forums, chat groups, video platforms, service organizations, and peer networks. Only some become stable across platforms and generations. Current GenderLibs monitoring of yaoniang, MtX/MTX, and MTE illustrates this evidence problem. Public search surfaces contain semantic collisions and sparse samples, so responsible historical recording preserves concrete context and date while waiting for repeated independent use before assigning a stable definition. Kuar, by contrast, has a longer public chain across medical, psychological, and parent-support materials.

These three speeds explain why lexical change is asynchronous. A regulation may change once while media goes through several cycles of wording. A community may develop granular pathway terms while a hospital retains a clinic name inherited from an earlier diagnostic vocabulary. Historical analysis gains more from mapping reach and function than from arranging words on a single scale of linguistic progress.

9. Reading historical material: preserve the period word and mark the present standpoint

Period vocabulary carries the knowledge structure of its time. Some historical words now sound strongly pathologizing. Some continue to have technical force in archived regulations or medical records. Others have moved from common self-description into the archive. The historian’s task is to make these differences legible.

A practical format is original term + institutional role + date + present gloss. For example:

  • 2009, health administration / medical technology: the national standard uses bianxing shoushu and yixingpi bing, reflecting the regulatory and clinical language of that document;
  • 2016, national survey / research: transgender enters a national-scale social survey and health project as a population and rights category;
  • 2018, hospital clinic: “Comprehensive Treatment Clinic for Yixingzheng” records the clinic’s own service vocabulary;
  • 2022, national medical-technology regulation: “gender reassignment technology” becomes the title of the restricted-technology standard;
  • 2020s, community service: kuar and related terms appear in psychological, parent-support, and resource-navigation settings as mutual-aid and relationship language.

This format makes several vocabularies visible at the same time. It is also extensible. A newly discovered newspaper, hospital notice, forum archive, or oral history can be represented as another term card and inserted into the appropriate layer.

Digital archives are especially compatible with this method. The Chinese Transgender Digital Archive preserves organizational materials; the Transgender News Archive preserves news texts; the Sinophone Transgender Chronicle offers chronological indexing. An archive page has its own capture or compilation time, while the preserved item has an earlier publication time. Recording both helps distinguish present-day retrievability from contemporaneous circulation.

10. Historical boundaries: geography, class, platform, and the source of a label

Surviving evidence has a geographic structure. Major hospitals in Beijing and Shanghai, national media, nationwide surveys, and long-lived organizations have relatively high preservation rates. Smaller cities, local groups, personal forums, discontinued websites, and offline mutual-aid networks leave thinner public traces. This public vocabulary history therefore describes language that entered preserved and searchable institutions. Everyday language was always richer than that record.

Self-description and external labeling also require separate fields. A newspaper calling a person bianxing ren documents the newspaper’s category choice. A hospital writing yixingzheng patient documents a clinical interface. A survey participant selecting transgender sits at the intersection of research classification and personal identity. A person may also change self-description across decades, platforms, and relationships. The self_or_external_label field preserves that distinction.

Regional scope matters as well. Chiang’s Transgender China and Transtopia in the Sinophone Pacific compare mainland China with Taiwan, Hong Kong, and a wider Sinophone world (Chiang 2012, 2021). This essay keeps mainland institutions at the center while using Sinophone scholarship as a contextual frame. The approach captures transregional circulation of concepts while preserving differences in law, healthcare, media, and movement infrastructure.

A further boundary concerns the archive itself. Search engines and digitization can make an old word look newly prominent because a newspaper database, scan, or community archive became searchable recently. Conversely, the disappearance of websites can erase evidence of a term that was once common in a particular community. record_time and archive provenance therefore matter as much as the visible publication date.

11. Conclusion: transgender language history is an institutional map

From the 1980s through 2025, public language for gender transition and transgender life in mainland China expanded through several channels. The media-personhood layer made bianxing ren a familiar narrative category. The clinical layer connected yixingpi / yixingzheng to diagnosis, clinic organization, and treatment pathways. The administrative layer wrote bianxing shoushu, household-registration sex fields, legal gender recognition, and gender reassignment technology into procedures. The community and research layer gave transgender, kuar, and more granular pathway terms roles in surveys, services, mutual aid, and self-description.

Together they form a vocabulary stratigraphy. A new word can rapidly become dominant in one setting while older institutional language remains active elsewhere. Historical meaning therefore comes from four coordinates: who uses the term, whom or what it refers to, which institutional action it performs, and when that use occurs.

For archival work, this makes terminology verifiable. Each new source can be recorded with its original form, speaker, institutional function, event time, record time, self/external-label status, and later gloss. As evidence accumulates, the history will reveal finer regional differences, institutional migrations, community innovations, and personal voices.

The same model points toward the next research tasks. Local hospitals and city histories can deepen the clinical layer. Early newspapers and television archives can thicken the media layer. Police, education, employment, and court records can expand the procedural layer. Forums, hotlines, parent networks, volunteer oral histories, and digital preservation projects can expand the community layer. Connected together, these records can become a continuously revisable institutional map of transgender public language in mainland China.

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