Traditionally, Chinese opera companies were single-sex troupes. In an all-male performing group, both male and female roles were played by men. Female-role actors often carried their roles offstage into the realm of prostitution. The 19th century novel Precious Mirror that Ranks Flowers describes wealthy men's patronage of female-role actors "who have all the beauty of women, but not their anatomy."

Accounts of MTF lifestyles also exist outside the realm of theater/prostitution. The 17th century writer Li Yu(李煜) wrote the fantasy tale  in his Pantomime anthology. It is the story of a young widower Jifang who falls in love with and marries a teenager Ruilang according to the male-male marriage custom of their province. But by the same custom, the same-sex marriage must be dissolved when the time comes for the youth to take a wife and fulfill his duties of perpetuating the family line. To avoid this impending separation, Ruilang castrates himself and begins living as a woman. When Ruilang's husband dies later, she dutifully raises Jifang's son from his previous heterosexual marriage. While Li Yu's account is fictional, an earlier record from the 16th century tells of a biological male who made a gender switch at age 40 and married a male friend.