Is India Opening Up to Sex Change?

12 years after Ajay Mafatlal underwent a sex change, here’s a look what has changed for trans-people in India

• Plastic surgeons in Delhi and Mumbai say, they are doing 20-25 each year, there are no pan India numbers for sex change surgeries
• The cost of the surgery for male-female is around Rs 2 to 5 lakhs while female-male is between Rs 4 to 8 lakhs
• One government hospital each in Kolkata, Hyderabad, Telengana, Delhi, and Chennai, does sex change surgeries for free

Way back in 2003, Ajay Mafatlal did a Caitlyn Jenner in India. Back then, crossing the gender was the stuff of fantasy, which only the faceless-uber-rich people could think of doing.

Fast forward to 2015, a lot has changed for trans-people in India; the number of sex reassignment surgeries (SRS) across the social spectrum is growing, with surgeries happening widely in Bihar, Andhra Pradesh and parts of Tamil Nadu. In some states, like Maharashtra and West Bengal, government hospitals are also wielding the scalpel with impunity. However, for people who undergo a gender change, every day is a new battle for social acceptance.

But the whole circus surrounding gender transition does not reveal the fragility, risks or the emotional upheaval that are a part of a sex reassignment surgery.

What is a Sex Change Surgery?

This complex procedure is not just a realignment of sex organs; it involves a series of surgeries with a team of experts from the psychiatrist department, cosmetology, endocrinology and anesthesia. A full blown gender-change surgery includes:

• Genital reassignment
• Chest reconstruction
• Multiple facial reconstruction surgeries
• Breast augmentation
• Tracheal shaving
• Extended hormonal therapy

Now cosmetic changes; breast implants and the whole feminisation aspect, is not a necessity for a person dealing with a gender identity disorder. The cosmetic operations are done to align the physical appearance with the gender identity.

The first twelve months are difficult. An individual has to undergo 12 months of continuous hormone therapy under the supervision of a physician. The hormone injections are very expensive, cost thousands of dollars a year, and like all drugs used for transgender treatment, they are not approved by the FDA.

In this period of one year, cosmetic surgeries can be carried out, but doctors strictly advise a one year gap between cosmetic changes and a genital reassignment procedure.

Sex change is a series of irreversible operations and 40% of transgenders regret their decision later in life, more than 30% attempt or plan suicide.(Source: The World Professional Association for Transgender Health)

During this period, any kind of anxiety or depression has to be treated clinically. Anyone undergoing a sex change operation will have to take hormonal injections for life. Since this is a fairly new science, long term effects of these therapies are not known.

Sex Change Laws in India

In 2014, a landmark judgment passed by the Supreme Court recognised transgenders as the third sex, allowing them equal access to education, healthcare and employment, and prohibiting discrimination against them.

In 2012, the Supreme Court ruling in the Nalsa judgement affirmed the constitutional rights and freedom of transgender people.

The Nalsa judgement triggered Aamir’s (name changed) need to assert his gender of choice when he started his transition to being a woman. Last year, this 31-year-old, now settled in Seattle and working in one of the Big Four, was tired of leading two separate lives, but the process to legally blur those lines was painfully cumbersome.

He had to come back to Mumbai, to file an affidavit in court but the judge refused to accept his statement. After two months, he went back for a second attempt at convincing another judge. He too seemed unaware of how to go about such a case, but accepted it after Aamir’s insistence. This time, Aamir was armed with pages from the Nalsa judgment, the 2012 Supreme Court ruling that recognises the right to determine and express one’s gender.

The whole court validation process took almost a year. The full effects of his gender change surgery also took that amount of time to show. I asked him, why would anyone take that kind of pain? Why not just start living the life of the other gender?

After months of suffering from ankle fracture, my mother decided to seek surgery. It had become that painful, she said only moments before her operation. I asked her to think about that analogy in relation to those transgender individuals who have lived their lives in the closet for so long... Now you understand?
– Aamir, Transgender

If you approach the topic from this perspective, it makes total sense.