Changing gender is no easy task in India

As old as the Kama Sutra, South Asia’s hijra communities are one of few transgender sub-cultures around the globe with such a long history.

Hijras are men or hermaphrodites who identify as women. They are a marginalised caste that generally ekes out a livelihood through performing, begging and sex work. Some hijras choose to undergo ritual emasculations in which the penis and testicles are removed, and boiling oil is used to cauterise wounds. The ritual includes a pre-dug grave for the bodies of patients who do not survive.

Medical options

There is a safer transformation available to people in India, an option that enables people to change their sex outside the hijra traditions. A few medical teams around the country offer gender reassignment therapy.

“We don’t get many patients for gender reassignment; maybe six to ten people per year,” says Dr. Sajal Haldar. He is the cosmetic surgeon for a team that provides treatment in New Delhi. “Expense is the main concern.”

Haldar says the therapy is complex. To transform a man to a woman requires breast implants, castration, penectomy, construction of a vagina and countless other procedures. Changing a woman to a man is just as complex, and both transitions require ongoing of hormone treatments. Haldar says the entire process can cost up to three lakh rupees, approximately 7000 USD.

Cutting corners

For many people in India, that price tag is just too high. Christy Raj, a citizen journalist from IndiaUnheard, recently produced a story about a person who chose a cheaper path, with dire consequences. Sneha Prabha says that she paid between two and three lakh for treatments that included castration and vaginal construction, but left her with pain and urinary tract problems. Prabha says she had some procedures done illegally, and that left her with no recourse for the botched surgeries.

Raj is also transgender. Born with a female body, he lives as a man. Raj says he is scared to start gender reassignment therapy because of stories he has heard about surgeries gone wrong. He believes that Indian law about sex change operations are unclear; he has seen a lot of confusing information about what treatments to get, and where. “Without having any proper information, I cannot get it done and harm myself.”

Legal but taboo

Dr. Richie Gupta says gender reassignment therapy is legal in India, “but there is a lack of information and education about it.” In fact, since 2006 government hospitals in Tamil Nadu are obliged to pay for gender reassignment therapy. Gupta says the only legal hurdle to treatment is that would-be patients have to undergo a psychiatric evaluation to determine whether they are truly transsexual.

Gupta agrees that cost is a barrier in parts of the country where people have to pay for their own treatment. There are social barriers as well. “There is a strong familial stigma about being transgender,” says Gupta. “The family fabric is very strong here. People rarely go against the wishes of their family.”