A case of identity

With the rise in Sex Reassignment Surgeries in India, can we expect some acceptance from the surrounding cultural milieu?

There is a marked rise in Sex Reassignment Surgeries in India over the past few years, despite the long and arduous process involved.
India is one of the few countries that offer Sex Reassignment Surgeries (SRS) at comparatively affordable rates. People are coming in from all over the world to avail the facilities here in India due to the price at which it is offered — although, for the middle-class Indian, raising the money is not that easy.
Dr Narendra Kaushik, surgeon at Delhi’s Olmec Cosmetic Surgery and Hair Transplant Centre, has been a practising plastic surgeon for SRS for over a decade. At least five international patients come in every month, to his practice alone. Moreover, he says that SRS within Indians has seen a rise by about 70 per cent as compared to five years ago. Dr. Kaushik says that the primary purpose for SRS is to bridge the differences between body and soul, for those with gender dysphoria.
The doctor also points out that while more Indians are opting for SRS, there has been a marked dramatic increase in female-to-male transitions, as opposed to a few years ago. “For every four male-to-female surgeries, I did one female-to-male surgery. But now, it stands at almost equal numbers, and that is definitely an improvement,” he says, “And what’s more, I’ve come to observe that family acceptance is also higher when it comes to female-to-male transitions.”
Preceding the actual surgery, the patient is required to go through at least a year of hormone replacement therapy (HRT). The medication costs close to Rs 3,000 a month. During the course of HRT, those undergoing the treatment must also take counselling sessions with psychologists and psychiatrists who work to ensure that the patient is ready for the operation and is entirely aware of the consequences of the decisions he or she has taken.
Once the medical transition is complete, the patients are then subjected to a real-life test (a step that may or may not be foregone) for about six months, wherein, before the surgery begins they are expected to engage in real world scenarios as the opposite sex. For instance, a male undergoing treatment for a male-to-female SRS would dress and behave like a woman in public, still in their male bodies. The process of SRS attempts to make the integration of the individual into society post-surgery as smooth as possible.
Following this step, the various surgeries begin, starting with breast surgery. Prior to the actual SRS wherein the genitals of the individual are restructured and altered, a final go-ahead is required from either two psychiatrists or a psychiatrist and a psychologist. This is to ensure that the patient is entirely sure that they want to go through with the procedure and are fully aware that it is an irreversible one.
And finally, those that opt to undergo the entire process of changing into male or female, go through surgery to change their facial features and figure in accordance with their new gender. By February 2019, Dr. Kaushik aims to open his own hospital exclusively for trans men and women – “so that at least in one place, they can stand in the queue of their choice!” he smiles.
Jolene (name changed), a filmmaker from Bombay, tell us about how difficult the process of HRT was for her. It is a time when one is caught in between both the male and female psyche, and a lot of hormonal disbalances take place in one’s body, resulting in a change in demeanour and looks. “Your features, our facial hair, all begin to look a little different, and all of a sudden, even those who did not know about my plans of surgery, began to look at me strangely. It really is a commitment that you give yourself over to, for the long haul,” she says.
It’s been two years since Jolene, now 31, has had her surgery, and while medically her procedure was rather sound, emotionally it was something of a roller coaster ride. She attempted to raise money via Ketto, the Indian crowdfunding platform, and was partly successful. In addition to the money that was raised, she had to take a bank loan and is working to pay it off. Her SRS alone cost about Rs 2.5 lakh. The entire process costs at least double that amount, with the laser treatment and face feminisation included.
She even had to spend a considerable amount of time to have her gender changed in all of her identity proof documents, from male to female.
In a male to female SRS procedure, one needs to undergo laser therapy to have facial and body hair removed, followed by Facial Feminisation Surgery (one may opt out of this at will), followed by the actual SRS procedure which includes the breast surgery and vaginoplasty. A recovery period of at least three weeks is required post-surgery.
Falak (what he wants to be called post-surgery), from Telangana, is still jumping over hurdles to get an SRS. All of 34 now, Falak realised that he was different when his parents began to prepare to get him married. Having already dealt with bullying and harassment in school and his previous workspaces, this was the last straw, and he decided shortly after that he wanted surgery.
At the time, however, Falak was not able to afford surgery on his meagre salary, and enlisted the help of the Ketto Foundation, which too could not raise sufficient funds. In the following years, he was responsible for the marriages of his siblings, and could not therefore afford his own operation. He has now finally begun his HRT dosages and is looking forward to the procedure. “I don’t care how old I am, or where I am. At whatever point in my life I may be, I want the surgery. It’s my personal goal. I can’t rest until I feel entirely like myself, body and soul.”
Falak is of the opinion that although the conditions in India are not ideal, they are getting better. He considers the blurred lines and intersectionality when it comes to sexuality and gender most dangerous. “People often mock trans people by calling them hijras. They must understand that the intentions behind sex change for those termed crudely as hijras, and the majority of the trans community who undergo the operation, are very different,” he says. “More often than not, they do not have a choice in the matter. But those that opt for surgery make a conscious choice to bring about a change in our lifestyles. The equating of the two, is inaccurate.”
Dr Kaushik also weighs in on this subject, saying that many in the hijra community are also taken advantage of. And besides, “The trans community that we refer to as hijras is an extremely proud one. They have a culture of their own, which after so many years, they are reluctant to give up.” According to him, they have developed a sort of immunity to the taunts and a comfort with their circumstances, and continue to make the most of it.
The clarity and passion with which Jolene and Falak expressed themselves, not to mention the drive of those involved in charities and foundations that champion these causes, is impressive. All they are trying to do is find their true place in the world.