Chicago-based Nina Chaubal says she hasn’t visited India for a “really long time” now. Nina, a transwoman in her mid-20s, left Mumbai for the US in 2009. There, while in college, she “came out” as a transwoman in 2013, and got gender affirmation surgery (GAS) too.
Back in Mumbai, however, none of this was possible: Nina’s family wasn’t supportive of her identity as a transwoman, and it was hard for her to imagine a “life she wanted” in India. After college, Nina moved to California and worked as a software engineer with Google for a few years. Last year, Nina got married too.
About a year and a half ago, she co-founded Trans Lifeline, a helpline for transgender people in the US and Canada, with her partner. The helpline receives calls from all over the world, with a small percentage of the callers being Indians as well. “Indian callers are mostly concerned about not being able to find work, and not being comfortable in coming out,” she says.
The situation of those turning to Nina’s helpline needs to be understood in the current context of transgender rights in the country. In 2014, the Supreme Court’s (SC) recognition of the legal status of “third gender” (aka, The National Legal Services Authority judgment) and the right to determine and express one’s gender came as a shot in the arm for transgender rights. According to the judgment, the definition of “third gender” included those who “intend to or have undergone sex reassignment surgery” or “transsexuals”.
Earlier this week, the SC clarified that “third gender” does not include lesbians, gays and bisexuals.
For many in the trans community, however, manoeuvring the claims of identity can be tricky. Some such as Nina, for instance, say that they do not want to be categorised as “third gender”, and instead want to conform to the gender binary, that is, male or female. “There’s anger within the community over the fact that in India, the term “transgender” gets associated with “hijras” , and the voices of the transmen and women get erased,” says Vinay Chandran, executive director of the Bengaluru-based Swabhava Trust, an NGO working with sexual and gender minorities. At times, this association might stall their chances of getting access to surgery or, even a change in their legal documents.
The progressive judgement apart, the process of aligning their body with their gender remains a fraught one – there are multiple battles to be fought on the medical, social and legal fronts. To begin with, a lack of support from the family ends up limiting the choices that transpersons might have. “Many parents will come and threaten us because they find it hard to comprehend why we would need to change their son or daughter’s gender,” says Dr Mahesh Mangal, chairman, department of plastic surgery at Sir Ganga Ram Hospital.
Even as Thailand remains one of the most popular destinations for GAS, India is fast progressing towards a destination for both domestic and international clients, confirms Dr Richie Gupta at the Gender Clinic at Fortis, Shalimar Bagh, Delhi.
But for many who plan to undergo the arduous process of surgery, lack of support from the family often translates into struggling to keep up with the medical expenses. The cost of aligning the body to suit the gender (including genital surgeries) can go up to Rs 8-10 lakhs at a private hospital in Delhi.
While the surgery is free in government hospitals, some such as Manvi Vaishnav, a Baroda-based transgender activist with the Lakshya Trust, say that doctors in government hospitals are either not trained to offer the surgery, tend to refuse it on flimsy grounds, or dilly-dally the right treatment, prolonging a transperson’s distress and anxiety. “It took me five years to get the complete set of surgeries for my transition. Ultimately, I had to turn to a private hospital,” says Manvi.
However, some transsexuals feel that, at times, access to doctors who can diagnose Gender Dysphoria and prescribe the right treatment can be challenging too. Advik (he chose to reveal his first name only), a psychologist who is currently in the middle of his transition, says that it’s important to get to the right doctor. In a moving post on his blog, he writes about his struggle of going from “hospital to hospital, doctor to doctor, for not days, not week, not months, but years, to get permission from those strangers, to live as what I am”.
Doctors can get prejudiced when it comes to Gender Dysphoria. Both Chandran and Nina feel that since there are different levels of dysphoria – some may not want or need surgery, while others may really need it – doctors need to be careful in dealing with individual concerns and needs. “Doctors need to understand that gender exists out of the binary of a man and a woman,” says Vinay, LGBT activist and co-editor of Nothing to Fix: Medicalisation of Sexual Orientation and Gender Identity. According to the World Professional Association for Transgender Health, dysphoric persons and “gender non-conforming” people (refers to the extent to which a person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex ), are different and the diagnosis has to factor in individual needs. Vinay also points that within the trans community, transmen have a harder time. “Doctors will not blink if a woman wants breast enhancement. But they can be very prejudiced when a woman wants to remove her breasts,” he says.
The surgeries required for a “female to male operation” is more complicated, expensive and hence, many transmen may stop at breast reduction, as it allows them to pass as a man. “It is ironical though that our society is prejudiced against a boy showing signs of feminine behaviour, and so, they are easily ‘found out’ by the family and might even end up getting treatment earlier. However, a woman acting tomboyish is acceptable, and the dysphoria might not be ‘found out’ that soon,” claims Dr Gupta.
Changing documents such as passports can be frustrating for transpersons: the term “third gender” can be confusing for government officials, and for those who may want to opt for the category to claim benefits, it can be an uphill task. For others such as Nina, who don’t wish to claim that identity, the hassle of dealing with bureaucracy and having to explain one’s gender can be a deterrent. “I am a woman. My passport says I am male, but my body and my appearance are that of a woman,” says Nina, who holds an Indian passport. “Gender is deeply ingrained in you early on in your life. It’s traumatic to be denied something that is so integral to you – just because for some people, it is hard to understand that others may be different from them.”