Here's what it takes to undergo a sex change surgery

Dr Rajat Kapoor at St George Hospital. Pic/Suresh Karkera

Beed constable Lalit Salve seems to have kicked off a revolution. Ever since the saga of his sex change, after living all his life as a woman, was keenly followed through newspaper reports, there has been a flood of inquiries about the medical procedure. Salve, who found immediate acceptance from his family and villagers, seems to have helped correct the stigma attached to sex change. St George Hospital, where Salve had the procedure done, is seeing a rise in inquiries and patients. Interestingly, the patients have been coming in with their parents and family, unlike earlier when friends accompanied those wanting the procedure done.

Dr Rajat Kapoor, a senior plastic surgeon from St George Hospital, with over 13 years of experience, has successfully performed as many as 17 genital reconstruction surgeries along with seven sex change surgeries while associated with JJ Hospital. Speaking to mid-day, he acknowledged that Salve's case has helped change people's perspective towards such surgeries.

Excerpts from an exclusive interview:

How do you decide if a person is ready for a sex change?
It is an individual's decision to change sex and we as doctors evaluate the patient minutely to see if he/she is ready for the transformation. They are counselled for days by two independent psychiatrists so that there is no room for doubt. In the process, we also ask them to cross-dress for six months in public so that they can feel the changes before undergoing the surgical changes as there would be no going back after that. If the reports show that they are confident about the change, we go ahead with the procedure. Sex reassignment surgery is the third stage.

What kind of person opts for sex change?
Often, a person who is physically a woman but identifies psychologically as a male, thinks she is trapped in the body of a woman and vice-versa. Recently, people abroad have started identifying themselves as gender fluid and gender queer, also known as non-binary, where they remain flexible about their gender identity rather than committing to a single gender. However, India is far behind in accepting people like this... It is true that Indians are still struggling to accept people like this, but frankly, there has been a huge change in perspective in the past few years. Earlier, 'these people' mainly came with friends as their parents would outright reject their gender preferences. But now, like in the case of Lalit or Rita, they are being accompanied by their parents or relatives who are extremely supportive of their decisions. When Lalit returned to his village, people welcomed him with open arms. Awareness is helping change the trend.

In most of the cases, it has been observed that those opting for sex change are mostly female. Why don't more men come forward for the procedure? Is it peer pressure?
To a certain extent peer pressure discourages men from changing into a woman. Family pressure forces men to withdraw from the process, whereas for women, acceptance is higher because they are turning into men. Girls are often called 'beta' by their parents, but have you ever heard a boy called 'beti'? Also, the procedure of changing a woman to a man is easier than vice versa.

How much does a sex change procedure normally cost?
The cost varies between R7-R10 lakh. But here, as it is a government hospital, it is done virtually free of cost. For other expenses, we have social workers who help arrange the money.

People often claim that changing the law of nature is harmful, and doctors are criticised for performing the procedure. Have you ever been faced with this?
Thankfully, so far, I have only been appreciated for the surgeries as it gives the patients a new life. But, it's their personal choice. Also, we take them under the knife only after full-fledged evaluations.

What is the demography of the patients you receive?
Most patients are in the age group 20-35. The oldest person who opted for sex change was a retired official in his 60s. They come from all strata of society.

Has a person ever stopped the surgical procedure after getting cold feet?
Once, I had a patient who wanted to undergo sex change. She was accompanied by her girlfriend whom she wanted to marry. After her first procedure, the family of the girlfriend got to know and forcibly got her married to a man. The disheartened patient did not want to continue with the procedure. So, yes, it happens when the family puts too much pressure on them.

Expert Speak
Sexologist
Dr Mahindra Wastsa, a well-known sexologist, said when children reach puberty, they get the feeling that they belong to a different gender. "When they grow up and start playing with the same gender, and find themselves attracted to them, they gradually understand that they are trapped in the body of the wrong gender. So, it is also a hormonal and emotional need that forces them to decide to change their sex."

Psychiatrist
Psychiatrist Dr Shubhangi R Parkar explained, "In their minds, they know exactly which gender they identify with. Before undergoing the surgery, they may have already gone through the phase of adjusting with people, environment and inner conflicts. They suffer a lot because of social stigma and get crippled inside because of being forced to live in the wrong body. But the suffering makes them mentally stronger to accept the change once the medical procedure is done with. However, people often see them differently after the change but because physiatrists have already prepared them for this change in attitude, they are able to withstand it much better. The desire for sex change can come as early as at 5 years when kids suffer from gender identity disorder. It's completely biological and one has no control over it."

Also read: Lalit Salve's stay inspires intersex ward at St George hospital

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