Distant dream of sex reassignment surgery
With government hospitals lacking mandated hormonal therapy and counselling facilities for transgenders and private hospitals super expensive, sex reassignment surgery is beyond the reach of transgenders.
“I’ve been saving money for two years. But the day I can have my surgery seems far off,” said Shital Chauhan, as she sat sipping coffee in a café.
Wearing a green salwar-kameez and red lipstick, the 32-year-old transwoman of Sanaur village in the Patiala district of Punjab was talking about her sex reassignment surgery (SRS).
“Every government claims that they excel in healthcare. But is it inclusive? Why are we, the transgenders, invisible to them?” she questioned.
Chauhan is one of the thousands of transgender people who find it difficult to undergo SRS because government hospitals – though mandated to offer such facilities – have little to offer and private hospitals charge extremely high rates.
Marginalised by society
Chauhan was 13 when she came out.
Acceptance at home was not such a big deal, but in the wider society it has been a challenge.
My friend was discharged two days after the surgery and returned to Punjab. She had extreme pain on the third day. And on the fourth day she died.” -Ranu Singh
“I loved dressing like my mother since a very young age. As a kid, I would wait for my parents to leave and then wear my mom’s sari, bindi and do a make-over to feel feminine,” she said.
When Chauhan told her mother that she wanted to live like a woman, her mother was shocked.
“But gradually she came around and accepted me. And so did my entire family. But it’s hurtful when other people treat us differently,” she said.
That is why Chauhan, and many like her, are desperate to get SRS as they believe it will complete their transition.
Missing government mandates
According to the Transgender Persons (Protection of Rights) Bill, 2019, the government must take steps to provide health facilities to transgender people, including sex reassignment surgery.
In 2020 the central government mandated at least one hospital in each state offer SRS along with hormonal therapy, according to media reports.
Section 15 of the Transgender Act also mandates the government to provide hormonal therapy and counselling, both before and after SRS.
However, there are no reports or audits to show if any state government executes these mandates.
“So far no trans community has approached us for such facilities. We will request the government to look at this issue as and when they approach us with their demand,” Arvind Pal Singh Sandhu, Director, Social Security, Women and Child Development of Punjab, told Village Square.
High-cost surgery in private clinics
“I know many people who got SRS done in private hospitals. But they have a good bank balance, unlike me,” said Chauhan.
After all these years and facing discrimination at every single step of life, I have no hope of help from the government anymore. -Ranu Singh
Chauhan has a long wait to get her SRS done, which would include breast reconstruction or silicone implants. But her transwoman friend, Ranu Singh, has lost hope of surgically transitioning.
“I’m 38 now. When I was young, I had dreams of living in the body which my mind lives in. But after all these years and facing discrimination at every single step of life, I have no hope of help from the government anymore. But I feel fine with how and what I am,” said Singh.
The cost of SRS at private hospitals can range between Rs 2 and 5 lakh for a male to female transition. For a female to male transition it is anywhere between Rs 4 and 8 lakh.
While the costly surgery is the final step in the transition process, the post-surgery medication and therapy are added expenses.
A year of therapy with a psychologist is compulsory before undergoing physical transition. This includes two to four sessions a month which can cost Rs 1,000 to Rs 1,500 per session, bringing the total cost to about Rs 48,000 to Rs 72,000.
Another transwoman of Patiala, 34-year-old Sukkhi, plans to borrow money from three friends to undergo SRS.
“Two years ago I had convinced them to lend me around Rs 60,000 each, which I would return in installments with interest. But the lockdown paused it all. I had planned to get my SRS done in Chandigarh. I am expecting the loan later this year,” she told Village Square.
Not every surgery ends well
There are certain states, like Karnataka and Tamil Nadu, which have provisioned free SRS in government hospitals. But because of some poor treatments, the transgender community has developed a mistrust.
And while some private clinics charge very little, surgeries can be botched up.
Ranu Singh lost a friend after she underwent SRS at a private clinic in Uttar Pradesh.
“She was just 24. She decided to undergo the surgery in a clinic in Noida because they charged just Rs 70,000,” she said.
“My friend was discharged two days after the surgery and returned to Punjab. She had extreme pain on the third day. And on the fourth day she died,” said Singh.
HIV an added concern
For Chauhan, who used to be a sex worker, money is not the only challenge.
She tested positive for HIV.
Chauhan now works with a non-profit organisation that counsels transpeople about safe sex and HIV.
“Before getting this job, I used to be a commercial sex worker. I was also in a relationship with a man for quite some time. I don’t know from whom, but I contracted HIV,” she said.
According to the Transgender Persons (Protection of Rights) Bill, 2019, the government must have separate HIV surveillance centres. But it is not clear how many facilities exist.
“SRS in itself is a complex surgery to perform. To perform it on a HIV positive person, a lot of precautions need to be taken,” said Neelam Singh, Lucknow-based gynaecologist and director of a non-profit organisation, Vatsalya.
The massive gap between legal promises for transgenders and their enforcement further pushes them towards the margins.
“I don’t have money to go to private hospitals. So I go to the government hospital for the medicines. Every time the people there look at me as if I’m some alien,” Chauhan told Village Square.
The lead image at the top of this page shows a Punjabi transwoman, who hopes to borrow money for her sex reassignment surgery (Photo by Jigyasa Mishra)
Jigyasa Mishra is a journalist who writes primarily about women’s issues and public health, from north India. Also read do read about Ashfa, a transwoman living in Varanasi, despite the lack of employment opportunities for transgenders and mostly limited to commercial sex work which leads to humiliation and exploitation, lives life to the fullest with her friends.
