"Sex change was a taboo subject that was rarely discussed, but it is now being talked about openly," says psychiatrist Yusuf Matcheswala, who had evaluated Baruah’s psychological readiness for the gender-changing surgery.
His ‘outing’ has resulted in a faster flow of enquiries at plastic surgeon Anil Tibrewala’s clinic at Hinduja Hospital, Mahim.
Twenty-one-year-old Bidhan Baruah had moved Bombay high court seeking permission for a sex-change operation after his father in Assam threatened legal action against the doctor who agreed to oblige him. The court has since ruled that he is an adult who can decide on the issue, but there is still no clarity on when and where Baruah will undergo the surgery.
But he has inspired many to ask questions. Dr Anil Tibrewala, who is among the handful of plastic surgeons in Mumbai who perform sex change or gender reassignment surgeries, says, "In the last few days, I have spoken to four persons from different corners of India seeking the operation." One of the callers from Haryana, a woman, wanted to know the cost of the surgery.
"When I told her that she needed a masectomy (removal of breasts) and hysterectomy (removal of uterus) before the main operation costing Rs 2.5 lakh, she said she would be landing in Mumbai soon," he says.
Clearly, there is a silent section that identifies with Baruah is now seeking help, adds Dr Tibrewala. Psychiatrist Harish Shetty believes the numbers seeking surgery will go up in near future. "In the last three years, the number coming to discuss gender identity disorder (GID) has gone up," he adds.
Consider the gender reassignment surgery programme at Kokilaben Ambani Hospital, Andheri, which has 15 transgenders in various stages of treatment. Urologist Sanjay Pandey says, "Our programme is over 10 months old and our patients have, after months of hormonal treatment and intense psychological profiling, started undergoing the main surgery." Their first case was a male-to-female surgery last month and the second – a female-to-male surgery – will follow in June.
Incidentally, more men than women suffer from GID. The February 2012 edition of International Journal of Urology said GID prevalence varied depending on the country. "For example, in the Netherlands, the calculated prevalence of adult GID was one in 11,900 men and one in 30,400 women between 1975 and 1992. In Germany, between 1981 and 1990, the prevalence of MtF (male to female) and FtM (female to male) was estimated to be 1:42,000 and 1:104,000, respectively," said the report.
Accordingly, there are more men than women who undergo the surgery. Also, plastic surgeon Ajay Hariyani, who is attached to the civic-run Bhagwati Hospital in Borivli, says the male-to-female surgery is easier to do. "Creating a vagina is easier than making a penis. Breast augmentation can be done and the hair (facial) can be removed with laser," he says.
Gender reassignment surgery, as the sex-change operations are known as in medical circles, is far from a new branch but there is a new dynamism about it now. Urologist Pandey says, "Plastic surgeons kept gender reassignment surgery alive for over two decades in India, but now there are new techniques in urology that will bring about a paradigm shift.” For one, he promises a single-sitting surgery instead of the two or more sessions for certain transgenders willing to undergo the surgery.
But it is this potential rush that worries activists like Ashok Row Kavi of Humsafar, which works for the rights of the LGBT community. "The main problem with the transgender community in India is the lack of a social support system," he says. If their families are not supportive of their decision to undergo the surgery, they have only one refuge: the hijra community, but "it’s not a simple issue", Kavi adds.
Secondly, there is no uniform protocol for gender reassignment surgeries; surgeons often follow their own schedules. "Any person undergoing a gender reassignment surgery has to undergo two years of intense psychological therapy along with their family. But this is rarely done in India," says Dr Matcheswala. Kavi concurs: "In Tamil Nadu, a letter from a hijra guru saying that the person has been staying with them makes them eligible for such a surgery."
Worse, there are stories of botched treatment and surgeries. Dr Pandey of Kokilaben Hospital says many of the 15 patients whom he and endocrinologist Dr Dheeraj Kapoor are treating, have had a problem from previous treatment. Kavi says, "We have a transgender who lost a kidney after having too much of hormonal therapy. Another person wasn’t operated on properly and has a leaking urethra that forces her to wear an adult diaper all the time."