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As many as 0.3% of people in China identify as transgender. China and greater China (the Chinese region, including People's Republic of China, Hong Kong, Macau and Taiwan (Republic of China)) have a long history of transgenderism.

Terminology
A wide variety of terms are used in relation to transgenderism in Chinese languages.

The standard Chinese term for transsexual people is 變性者, (py bìanxìngzhe), literally "one who changes sex". Bìanxìng 變性 is therefore the most common way to say "change one's sex", though not necessarily through sexual reassignment surgery—bianxing may also include hormonal changes and lifestyle changes.

In Mandarin, the term kuaxingbie (跨性别, pinyin kùaxìngbie), literally "to go beyond sex", has recently come into use as a literal translation of the English term "transgender", but kuaxingbie is not in popular use outside of academia.

Offensive terms for boys include “niang niang qiang” (meaning sissy boy) or “jia ya tou” (meaning fake girl).

Fanchuan (反串, fǎnchùan) is the historical term for cross-dressed performing on stage, as in Beijing opera where males play women's parts, or in Taiwanese opera where females play men's parts.

A common term for "ladyboys" or other transsexual people who perform on stage is renyao (人妖, py rényāo). This term is most specifically applied to Thai katoey, and almost never to Chinese transgender people. The term can be broken down as "human monster"; and while some would argue that yao here means "enchanting", the word has both connotations. In combination with its application primarily to non-Chinese, and especially southeast Asian, transgender people, it is a very offensive term. Chinese transgender people themselves almost universally avoid the term, favoring less insulting descriptions.

In the late 1990s, the performing group Red Top Arts (紅頂藝人, py Hǒngdǐng Yìrén) came to fame in Taipei, Taiwan as the island's first professional drag troupe. Since this time, "Red Top" and various homophones (紅鼎，宏鼎, etc.) have come to be common combining-forms that indicates drag, cross-dressing, etc.

Terms for crossdressing are many and varied. 異裝癖 (py yìzhūangpǐ), literally "obsession with the opposite [sex's] attire", is commonly used. 扮裝 (py bànzhūang), literally "to put on attire", is commonly used to mean crossdressing. Related to this is an auxiliary term for drag queens: 扮裝皇后 (py bànzhūang húanghòu), or "crossdressing queen". There are several terms competing as translations of the English drag king, but none has reached currency yet.

Two common terms for intersex people exist: 中性人 (py zhōngxìngrén), literally "middle sex person" (and perhaps indicating androgyny rather than medical intersexuality), and 陰陽人 (py yīnyángrén), or "Yin-Yang person".

Religion
Confucianism, one of the dominant religions in China, enforces and promotes traditional gender roles. Confucianism has a strong belief in maintaining men’s dominance over women and trans women are therefore viewed as shameful for expressing a lower status.

Buddhism views all bodily concerns as entrapment in the Samsara, equally including those concerns regarding LGBT+ identities and issues.

Socialism
Growing up in a socialist state prevents many from being accepted by both society and government. Socialism was a strong proponent and enforcer of gender roles in China. It strives to eliminate difference, reserving individuality for the national leaders. Youth are discouraged from expressing difference or exploring potential for individuality, such as nontraditional gender and sexual identities. Much of the homophobia and transphobia can be traced back to the decades-long exposure to this socialist propaganda. The attitudes of younger generations that have been less exposed to socialist ideologies are beginning to reflect more accepting attitudes towards members of the LGBT+ community.

Youth
Transgender youth in China face many challenges. One study found that Chinese parents report 0.5% (1:200) of their 6 to 12-year boys and 0.6%  (1:167) of girls often or always ‘state the wish to be the other gender’. 0.8% (1.125) of 18-24 year old university students who are birth-assigned males (whose sex/gender as indicated on their ID card is male) report that the ‘sex/gender I feel in my heart’ is female, while another 0.4% indicating that their perceived gender was ‘other’. Among birth-assigned females, 2.9% (1:34) indicated they perceived their gender as male, while another 1.3% indicating ‘other’.

One transgender man recounts his childhood as one filled with confusion and peer bullying. In school he was mocked for being a tomboy and was regularly disciplined by teachers for displaying rowdy boy-like behavior. Some recommended to his parents that he be institutionalized.

These attitudes may be slowly changing and many Chinese youth are able to live happy and well-adjusted lives as members of the LGBT+ community in modern China.

Social media and technology
Technological advancements help to promote greater awareness among youth of LGBT+ issues. Access to Western media, such as movies, trans-identifying characters, as well as trans-themed web sites are broadening the knowledge and sense of community many trans youth seek.

Laws regarding gender reassignment
In 2009 the Chinese government made it illegal for minors to change their officially-listed gender, stating that sexual reassignment surgery, available to only those over the age of twenty, was required in order to apply for a revision of their identification card and residence registration.

In early 2014 the Shanxi province started allowing minors to apply for the change with the additional information of their guardian’s identification card. This shift in policy allows post-surgery marriages to be recognized as heterosexual and therefore legal.