Is the rebirth clinic a ray of hope for gender correction seekers?

A month after opening, St George Hospital's dedicated clinic for sex reassignment stands as a beacon of hope, drawing people from afar. But the journey remains a long one

Sitting outside the Gender Reassignment and Cosmetic Surgery out-patient department (OPD) at St George Hospital, Rita Devi appears shifty and anxious. She has only a couple of hours to get a slew of tests done before flying back to Assam the next morning. Clutching a folder containing documents, Devi is soft spoken, to the point of being barely audible. But she makes herself heard when she needs to.

The 36-year-old, born in Hojai district of Assam, approached the hospital authorities for gender dysphoria - a condition in which a person does not identify with the gender they were born with.

The term made its way from medical circles to the Mumbaikar's living room when Lalit Salve, a police constable from Beed, fought a long and hard battle to retain his job after a gender reassignment surgery. His case not only inspired others to explore the possibility of gender change, but even prompted the state-run St George Hospital to open the ward. Launched on September 26, it aims to provide a safe and non-judgmental space for those considering sex reassignment. Until then, authorities would receive calls from individuals who were considering the step, but had no dedicated section to cater to them. "With the rise in enquiries, we felt it was time we started one," says Dr Rajat Kapoor, who operated on Salve. It's for the first time in Mumbai that a state-run hospital has acquired this facility. Since they opened, they have received queries from 13 persons who are in various stages of pre-surgery procedure. The demographic is a mix of candidates from metros and smaller towns.

The sex reassignment OPD was launched on September 26

Back at the hospital, Devi is waiting for her sonography reports. Like Salve, she too, works for a government agency, the Assam electrical board, and had to seek permission from the state for surgery. "It's only after I get my name changed, and my hormonal imbalance treated that I'll be able to go ahead with the surgery," she reveals. This won't be any time before next year. The fact that it can be a long drawn process and requires patience and mental fortitude is something that doctors warn patients beforehand.

"We expect patients to get a comprehensive understanding of the procedures, hormones, and other risks involved in such operations," says Kapoor. The hospital has set up a six-member committee to examine the individuals who wish to undergo gender change. The procedure also involves a mental health test to assess a person's readiness to undergo the physical and emotional stress that accompanies the transition. And then there is the " real life test" where, s/he must take on the role of the desired sex in everyday activities, both socially and professionally.

"Cross dressing helps them understand what it takes to live as a person of the other gender. It needs to be done for a minimum of six months. If they don't feel comfortable, they have time to rethink their decision," says Kapoor. While women transitioning to be men dress in androgynous clothing, it's the men to whom this rule applies more, he adds.

Dr Rajat Kapoor

Ameya (name changed on request), a teen from Kothrud, Pune, was told to take the "real life test" when he visited the hospital a month ago. But to him, it made no difference. Born a girl, Ameya has lived the life of a boy for 18 years. From going to a men's hair salon and dressing up "like a dude" to dating girls, he has always identified as male. Curiously though, he says he wasn't born this way. "When my mother was pregnant, the family was hoping for a boy since they already had a daughter.

So, unwittingly, they ended up treating me like a boy." Although a student at a girl's school, he would dress up like a boy when outside. "I started loving this life because most people were accepting of me. When I suddenly started getting attracted to girls [at age of 14], is when it got difficult," he says. The period was tumultuous, he recalls, until he began accepting his feelings.

Dr Yusuf Matcheswalla, Psychiatrist

He even started a Facebook account with his new identity, and would receive flirtatious messages from girls. "It was a good feeling," he gushes. This went on, until one day when he was 16, the parents decided it was time their daughter started behaving like one. "They wanted me to change my attitude. They started forcing me to dress like a girl, but it was too late. I had internalised my masculine identity. I couldn't and did not want to change."

He came out to his parents a few of years later. Today, he has his mother's support. This [parental backing], says Dr Yusuf Matcheswalla, senior psychiatrist practising at Gokuldas Tejpal Hospital and professor of psychiatry at Grant Government Medical College, is one of the most visible changes he has witnessed in the last five years. Matcheswalla has treated scores of patients battling gender identity disorder. "Earlier, when doctors would refer patients for a psychological evaluation, they would come alone. Today, they are accompanied by their families. It shows a growing level of acceptance," he says.

Matcheswalla says candidates for gender reassignment surgeries must undergo extensive psychiatric evaluation, and remain under the supervision of a therapist for at least two years. But, the suggestion is often met with resistance. "The thing is, you can't reverse it once it's done. Sex change regret can lead to crippling depression and even physical harm, which is why you need to be absolutely sure. But patients feel we are prolonging their suffering by recommending the test. Once they have managed to raise or save funds for their surgery, they want it done at the earliest." The cost of surgery ranges from R3 lakh to Rs 7 lakh.

In the past, Matcheswalla has rejected patients for being mentally ill prepared. He recalls the case of a medical student from Mumbai, who was suffering from dysphoria but also had a schizoid personality disorder, a condition in which people consistently avoid interactions. "It was important to treat this particular aspect before giving the green signal. After months of therapy, I have now given him the green signal."

While there is eagerness to undergo surgery, there is also fear of repercussions, says Salve, who often receives calls from individuals mulling the transition. "They are scared of the side effects, but doctors lay all facts on the table. For instance, for a transsexual man [assigned female at birth], genital surgery generally offers him male genetalia that can be used during sex. It does not, however, give him functional testicles.

Pregnancy, then becomes an issue," he says. But, it's the financial strain that has led many to wait up. "Getting the surgeries done in private hospitals is not cheap. We are trying to subsidise the cost of the surgery, making it one-third of what it currently is," says Madhukar Gaekwad, medical superintendent, St George Hospital. Money will not be an issue for Amey. But, convincing his parents might be. "Somebody told my mother that the surgery is risky, and might affect the kidneys, which is why she is not taking the initiative to complete it. I hope she gets over these fears."

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