As people around the world commemorate the Transgender Day of Remembrance on Nov. 20, a Beijing-based civil society group has published China’s first nationwide quantitative report on the status of the country’s trans population, which found alarming rates of family violence and depression.

Based on more than 2,000 valid responses — the largest such survey to date — the Beijing LGBT Center’s report points to a lack of access to medical treatment, domestic violence, campus bullying, and workplace discrimination as issues that take a heavy toll on the lives of transgender and gender-nonconforming people in China. Released alongside a five-minute video animation summary, the report describes itself as the trans community’s “collective coming out.”

Pipi, a 38-year-old trans woman from the northeastern province of Liaoning who helped design the survey questionnaire, says the report will help raise visibility of trans issues. Some of the findings are appalling: Of 1,640 respondents whose relatives knew about or guessed their gender identity, all but six reported experiencing family violence at least once.

Even compared to last year’s United Nations Development Programme survey, “Being LGBTI in China,” transgender individuals were nearly twice as likely as other LGBTI people to face extreme forms of violence: Twice as many were forced into conversion therapy, which often involves barbaric techniques such as electric shock treatment.

“The two most urgent problems I think we need to solve are related,” Pipi told Sixth Tone. “The first is understanding from family, and the other is adequate medical services.” She believes that if there were more trans-friendly health professionals to help demystify matters among relatives, it would be easier for trans people to gain support from family members.

Pipi noted a small but meaningful change in 2017: China’s medical guidelines no longer refer to transgender surgeries as “sex changes” and instead, following international standards, use the term “sex reassignment surgery.” However, only 14.8 percent of survey respondents who desired surgery were able to access it. In April, a teenage trans woman attempted to perform surgery on herself, and when she sought emergency assistance at a hospital in the southern city of Guangzhou, staff leaked her story and photos online.

Economic factors are a major barrier to accessing safe and effective hormone therapy or surgical procedures, as such treatments are not covered by the national health insurance plan. But sex reassignment surgery is a necessary prerequisite to changing one’s gender identity on official documents in China, a requirement that the report recommends abolishing.

Denial of access to appropriate health care, high rates of violence from intimate partners and family members, and discrimination at school and work have all contributed to poor mental health among trans people. The report found that more than 60 percent of respondents suffered from depression, and 12.7 percent had attempted suicide.

The report and accompanying animation end with a list of recommendations for both policymakers and the public on how China can increase justice, understanding, and acceptance for its trans and gender-nonconforming citizens.

In recent years, the Chinese public has paid more attention to gender minority groups due to increased efforts from equal rights advocates and a few transgender individuals entering the limelight. Jin Xing, the country’s most famous transgender woman, was controversially recognized on the BBC’s “100 Women 2017” list — though some have argued that she promotes sexist values.

Last year, a court in the southwestern province of Guizhou heard China’s first transgender discrimination case, which the plaintiff — known as Mr. C — won on Dec. 30, 2016. And 2018 will see Shanghai’s first Trans Pride, another addition to the city’s calendar of LGBTI events that already includes ShanghaiPRIDE — entering its 10th year — and Shanghai Queer Film Festival.

But though trans rights advocates hope for positive changes worth celebrating, the Transgender Day of Remembrance focuses on commemorating the fallen: In the last year, according to Transgender Europe, 325 trans and gender-diverse people were murdered around the world.

Contributions: Qian Jinghua; editor: Qian Jinghua.

(Header image: A march participant with fingernails painted in the pink and blue transgender flag colors at the Los Angeles Gay Pride Resist March, U.S., June 11, 2017. Robyn Beck/VCG)