Dr Ashish Rai
Anil came to my OPD a few months back, he was tall, had dusky complexion, a sparse moustache, a few strands of hair on the cheeks and a manly swag.
Before I could open his medical file, he told me that he had come for phalloplasty or construction of penis and had already undergone a breast removal surgery.
He was born a 'she.'
The moustache and other masculine features were a result of the hormonal therapy he had been taking for a while. He was accompanied by his father, and they had frequent arguments. His father was visibly upset but had given in to his daughter's will.
As I went through his medical history, memories of first such patient I got to meet flashed through my mind.
In the early 2000s, I was working as a senior resident at Lok Nayak Jai Prakash Hospital, Delhi.
She must have been in her early 20s. She would never come to the OPD, and rather wait for her doctor in the wards. No matter how long the doctor remained occupied, she would wait—at times till 4 in the evening.
She was a mystery to me. I could not understand why one would want to change one’s sex. How could one feel ‘trapped’ ( a word often used by people wanting to undergo a sex change surgery) in his/her own body?
Like many, I too used to ridicule the idea. I always thought that it could only be a result of some environmental influence. But the curious doctor in me wanted to peep into her life and one day my senior colleague--her doctor--gave me this chance. He asked me to meet her and take her detailed medical history.
There was a firmness in her voice and a determination in her eyes as she spoke. According to her, she had been feeling unusual since her adolescence, when her body started showing the contours of femininity.
I was excited, my heart was beating faster as I walked into the corridor that led to the ward where she was waiting. She too was nervous, I could see a few drops of sweat on her forehead.
I asked her why she wanted to change her gender. With a slight frown on her forehead, she said, "I don't want to answer this question again. Just remove my breasts, I don't want them. They are a burden for me."
There was a firmness in her voice and a determination in her eyes as she spoke. According to her, she had been feeling unusual since her adolescence, when her body started showing the contours of femininity.
She started tying her breasts tightly with a cloth to prevent them from growing. The cloth had pierced her delicate skin and left scars all around her breasts and abdomen.
But she was hardly bothered by the pain or the scars, all she wanted was to get rid of her breasts— for her the most visible sign of being a woman.
She had already changed her name. She wanted a surgery and she was ready to sell even her house for it.
She changed my attitude towards people with gender dysphoria or transgenders.
Though I never got the answer asto why they feel trapped inside their bodies because they are born with a definite gender, I realized how important sexual identity is for people.
When a transmale wants to undergo a sex-change surgery to become a man, she hates her breasts and menstrual cycle the most. She undergoes a series of surgeries—mastectomy (removal of breasts) hysterectomy (removal of the uterus), oophorectomy (removal of the ovaries) to get rid of all her female attributes.
She wants to remove any trace of hormones which makes her feel like a woman.
My patients gave me a glimpse into the complexity of the human mind. Our gender is an inseparable part of our identity and psyche and I am perplexed and unable to fathom—what must be going on in the mind of people who are not at peace with their sexuality/gender and feels alien in their own body.
At the same time, she also undergoes regular hormonal therapy to slowly convert her internal milieu from a female to male. The process involves taking testosterone (a male hormone) injections to feel masculine. She loves every little change these hormones induce in her body-- her voice acquires a manly touch, she gets a beard, her skin texture changes. What completes her journey from womanhood to manhood is yet another extremely complex surgery—construction of a new penis.
Similarly, a trans-female takes about one- and- half- years to undergo sex change—to get breasts and a vagina. There is a gradual change in voice. There are plenty of cosmetic treatments available to change the texture of her skin.
My patients gave me a glimpse into the complexity of the human mind. Our gender is an inseparable part of our identity and psyche and I am perplexed and unable to fathom—what must be going on in the mind of people who are not at peace with their sexuality/gender and feels alien in their own body.
Working with these people for a long time has made me appreciate their grit and resolve to fight against their own body to achieve their gender identity.
It has also made me understood that their distress is not just psychological but also has a biological or pathological cause to it for which they are not responsible.
Now I understand why that girl wanted to sell her house—probably the only asset she had. And why Anil wants to go to Dubai to earn more money so that he can fund his sex change treatment.
The writer is a senior aesthetics & reconstructive Surgeon, Jaypee Hospital, Noida
(Anil is not the real name of the patient)