Sex change surgeries: Taboos, no support keep patients away

Many ignore symptoms, the need for medical help when they feel opposite to their biological sex

Until he was 23, Pratik lived like a boy; he dressed like one and liked talking with them, not realising this inclination to being a man was more than just a phase.

It takes patients years to understand they may need medical help for gender dysphoria — a condition of feeling one’s emotional and psychological identity as male or female to be opposite to one’s biological sex.

“My most difficult years in school were class 9 and 10, when the principal issued a circular asking all the girls to wear only skirts, and not pants,” said Pratik (name changed).

At 25, the Infosys Chartered Accountant from Bangalore scheduled his first sex reassignment surgery.

It took Pratik two years and a lot of research to understand he may need medical help for gender dysphoria (GD) — a condition of feeling one’s emotional and psychological identity as male or female to be opposite to one’s biological sex.

Born in a joint family, Pratik said there was no discrimination when it came to sons and daughters. “I lived the life of a tomboy, not realising that my inclination towards being a man needed to be attended to seriously. I was focusing on my education and cleared the final CA exams. It was around the same time that my father passed away, and I suddenly became the breadwinner of a family of five,” said Pratik. This, he said, was the turning point in his life.

“After the death of my father, my family started looking to get me married. That was when it hit me. I needed medical help and started looking for options on the Internet.”

Pratik’s is a pattern followed by most people with GD. A recent study on family support and the social taboos against changing one’s sex showed that while GD usually sets in by the time a person is nine, 73 patients who were a part of the study only started showing symptoms at 25 — the “lack of social and informative support” being the cause, the researchers said.

It took Pratik a year to decide to undergo a sex reassignment surgery. His doctor, Parag Telang, a plastic and reconstrctive surgeon at Mumbai’s S L Raheja Hospital, ensured a psychological evaluation was done by two independent psychiatrists and one psychologist before scheduling the first surgery in January 2016.

“Compared to male to female SRS surgeries, female to male surgeries are a 100% more complex. We imbibe in the patients’ minds the change will only be cosmetic, so while they can continue to have sexual intercourse, their reproductive abilities will be completely affected,” Dr Telang said. Patients usually have four or five surgeries — breast removal, removing the uterus and ovaries, a genital reassignment surgery and one for voice modulation.

Telang said the quality of treatment and rise in the number of specialists with expertise in the field were making Mumbai and Delhi global hotspots for SRS surgeries.

“Two years ago, we would attend to one or two patients a week asking about GD and its symptoms. Now, we have at least eight or nine inquiring and taking psychological analyses,” said Telang.

People like Pratik have also become a ray of hope for many others, held back by the lack of support and the taboo surrounding changing one’s sex. The survey by Kolkata-based endocrinologists showed only 10℅ of the 73 patients in the study had their families and friends backing them.