Last Updated on October 9, 2023 by Neelam Singh
Thirty-five year-old Hari (name changed) was born as a woman but felt trapped in the feminine body. In April this year, Hari decided to go for gender reassignment surgery (GRS) and underwent masculinising chest surgery – removal of his breasts—at a hospital in Coimbatore. Hari, an autorickshaw driver, spent Rs. 1,10,000 for the procedure and is quite satisfied with the outcome. “I was uncomfortable with my breasts so I saved up money and decided on the hospital in Coimbatore, keeping the standard and quality of the hospital and its staff.” However, due to financial constraints and complications involved in penile construction or phalloplasty, Hari didn’t opt for the latter.
He chose Coimbatore as he didn’t find a hospital in his home-town Bengaluru, to his liking. “There are very few options in Bangalore. There are a few in Gujarat, but I wasn’t sure of the quality of healthcare, hygiene or expertise of the staff. Also, the hospital in Coimbatore was the only one that offered me a decent price.”
The surgery and its complexities
Gender reassignment surgery (GRS) assist people who identify as a gender other than the one that was assigned to them at birth. This treatment is also known as sex reassignment surgery (SRS). GRS or SRS are legal in India.
It’s a complex process that involves an array of procedures and interventions like feminising vaginoplasty for those opting for male to female transition, masculinising phalloplasty for female to male transition, metoidioplasty (clitoral release/enlargement, may include urethral lengthening, masculinising chest surgery referred to as top surgery, breast augmentation, facial feminisation procedures, reduction thyrochondroplasty (tracheal cartilage shave, voice surgery, hormonal therapy and counselling).
It’s a costly affair as well. Depending on the surgery and hormone replacement medications, the cost of a gender affirmation procedure in India can range from Rs 1.5 lakh to Rs 9 lakh. Prices vary between hospitals and depend on whether a surgery is performed for male or female transition.
More people opting for GRS
In recent years, India has witnessed a gradual rise in the number of gender assignment surgeries, reflecting a slight shift in societal attitudes and healthcare accessibility. This trend underscores a growing recognition of gender diversity and the rights of transgender individuals. Increased awareness and acceptance have contributed to more individuals seeking medical interventions to align their physical appearance with their gender identity. Moreover, legislative changes and healthcare reforms have made gender-affirming surgeries more accessible and affordable for a broader segment of the population.
The state governments of Rajasthan and Maharashtra have come forward to offer financial support for GRS. Tamil Nadu has reportedly established three multi-speciality clinics for transgender people to allow free transgender surgery and Kerala also offers financial assistance for the procedure.
According to a news report published in The Hindu, the Government Rajaji Hospital in Madurai’s transgender multi-speciality clinic performed 105 gender reassignment surgeries between January 2022 and January 2023.
Where the problem lies?
Despite progressive legislations, changing mindsets and awareness, GRS is still not the norm. Ananya Kumari Alex, a 28-year-old transwoman, committed suicide in 2021 following an allegedly unsatisfactory gender affirmation procedure at a private clinic.
A vulnerable group of people, the majority of those choosing GRS, lack family support. Many of them—especially transpeople—do not possess the necessary paperwork to be eligible for government assistance programmes. As a result, they enter small clinics with inadequate facilities and unqualified staff. These clinics effortlessly lure individuals who are eager to accept their new yet true identities.
Dr. Rajendra S. Gujjalanavar, HOD & Senior Consultant, Plastic Surgery, Sakra World Hospital, Bengaluru, agrees, “Yes, many of them are impatient and can’t afford to have surgeries in major hospitals so they end up going to small set-ups. We do have patients come to us with complications and we do surgeries to rectify silicone breast implants that have got exposed. Also, urinary leaks are the most common problem.”
Today, transperson Shaina is happy about her GRS but 10 years ago, when she underwent the surgery – breast augmentation and vaginoplasty—in a small-time clinic in Bengaluru, she wanted to die. “I was in excruciating pain. There was non-stop bleeding. I would keep crying and after 20 days, my guru took me to a clinic and the pain stopped,” says Shaina, who spent Rs. 80,000 for the surgery.
Shaina says she knows people who have gone through worse. “They were not able to pass urine. Some people get infections. Someone I knew only did top surgery and got an infection in the breast. She passed away due to those complications.”
It should be mentioned that there is tremendous pressure among the transgender community to have the procedure in order to be accepted and validated.
According to Dr. Mohan Keshavamurthy, Senior Director – Urology, Uro-Oncology, Uro-Gynaecology, Andrology, Transplant, and Robotic Surgery, Fortis Hospitals Bengaluru, “The entire procedure, if done properly, takes around 6 to 18 months and is done in 2-3 phases. “There are social, religious and medico-legal aspects to these surgeries and they require a multi-disciplinary approach. It involves urethra work, prosthetics, and microvasculary functions.”
Dr. Keshavamurthy who has performed 25 GRS to date, adds that funds pose a major hindrance to these people. “More often than not, they don’t have family support. It’s usually the elder sister supporting the younger one.” In the case of transpeople, most of them take loans from their gurus or financiers, with gurus vouching as guarantors.
Even though sex change surgeries are legal in India, perhaps due to medico-legal complications, few hospitals in India offer them and few doctors take them up.
Dr. Gujjalanavar, who is a member of the Indian Professional Association for Transgender Health (IPATH), “There is a lot of paperwork involved and in some cases, parental consent needs to be obtained. I am aware of a few court cases that are going on in this regard.”
He goes on to add that people should select a hospital carefully and understand all the aspects thoroughly. “One must go through psychological counselling before the surgery. One shouldn’t jump into it.”
Even though Shaina has herself gone through it, she has a word of caution for the others. “One shouldn’t go through it just because others want you to. I am lucky that my GRS was successful. What if the surgery is not successful? You must think about the physical, mental and financial repercussions before deciding for it.”
(Some names have been changed to maintain anonymity)
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