As the name suggests, Sex Change Operation is a medical technique used for surgically transforming a male into female and vice-versa by performing an extensive treatment plan which includes psychological transformation, hormone therapy and organ reconstruction.

The procedure is used by patients suffering from gender dysphoria or transsexuals. The cost of sex change operation in India starts at USD 5000, which is way nominal than other parts of the country. Medmonks wants to help transsexuals from around the world, lead a life as their identified sex by offering them economic options for sex reassignment operation.

A transsexual begins to feel like he/she is in the wrong body from the age of  3-4 years. In some cases, Gender dysphoria might cause depression in transsexuals because of the stigma surrounding the subject. Sex change operations have been proven to pose zero risks on the life of its recipients which makes it so popular and effective.

Top hospitals in India today, are reportedly performing over 100 sex reassignment surgeries in a year. The term transsexual is used for referring to an individual who has misaligned sex and gender. Usually, transsexuals become sure that they were not born with the same sex as their gender around puberty. But still the surgery is performed after thorough diagnosis of the patients by a team of psychiatrist.

This article talks about sex reassignment operation and the basic requirements for undergoing it. Dr Richie Gupta, Senior Consultant of Cosmetic Surgery department from Fortis Hospital, also explained the technicalities involved in this surgery and how the team handles such cases at their Gender Identity Clinic.

Difference between Sex & Gender

Every individual has two different identities; one is their sex and other is their gender. Sex of the individual is decided at their birth time. But gender is created by and is completely related to their minds. Gender is an inbuilt personal sense of resonating with female or male characteristics. In most cases, sex & gender of an individual, are in alignment. But when it comes to transsexuals, they have different sex and gender that create a conflict.

“The internal sex organs in your body defines the sex of a person categorizing them as male and female. Gender is what your mind says; it is inbuilt in the hardware. Gender of a person cannot be changed. Gender is a person’s self-perception of being a male or female. A person can look like a female, but their mind might say that they are male, as their sex and gender are not in alignment. We cannot can the gender, as it a product of the mind, but we can change the sex. This is done with sex change surgery or Gender affirmation surgery. The gender of the person cannot be changed,” Said Dr Richie Gupta, the Senior Consultant of Cosmetic Surgery at Fortis Hospital, Shalimar Bagh.

Gender Dysphoria

At the age of 3 to 4 years, a transsexual will usually begin to feel that he/she is in the wrong body. This often leads to causing conflict in the society amongst parents, social circle, and of course with self to find a true identity. This overtime causes the phenomenon of gender dysphoria. Gender dysphoria is a default condition in which an individual has opposite psychological and emotional identity than his/her biological sex.

Certain individuals can get into depression or become suicidal because of the severity of gender dysphoria. They often feel the need to get rid of their sexual organs, as it’s a major what part of what defines their genders. The acceptance of different sexualities and growth of LGBTQ community has helped in making sex reassignment surgeries available to individuals as an option.

Gender reassignment surgery is used for transforming a transgender’s physical appearance as well as the functionality of their existing sexual organs and socially associated characteristics to resemble their identified gender.

Results achieved by Genital Change Surgery

· Transformed physical appearance (Male will get breast and uterus implants, while female to male sex change surgery will include sexual organ reconstruction and removal of breast tissues)

· Hormone Therapy (Male to Female patients will be given estrogens & progesterone, and Female to Male will receive testosterone), for emotional and internal transformation

· Sex reassignment surgery enable transsexuals to engage in sexual intercourse with the opposite sex

What happens before the procedure?

Psychological Evaluation

Gender reassignment surgery involves a long process and not all candidates who apply for it go forward with the surgery, as it is a significant transformation, which is very demanding mentally and physically. So, the first step of the treatment involves the diagnosis of the transsexual. People willing to undergo a sex change operation have to consult with mental health professionals. Two psychiatrists have to analyze and certify him/her as a transsexual for the surgery. These criteria are used as a standard which was set by the World Professional Association for Transgender Health.

An individual is not classified to be transsexual merely based on their feelings. As in some cases, patients might be afflicted with other conditions like multiple personality disorder.

Candidate for Sex Change Surgery

· Psychiatrists work to rule out the possibility of the individual having other mental health disorders like schizophrenia or psychosis. The person has to be a transsexual.

· Intersexual patients or individuals with congenital defects are not suitable candidates for the surgery

· The person has to be transsexual (male/ female) without any underlying medical conditions.

· Another essential requirement involved in the diagnosis of sex reassignment operation includes the real-life experience of the individual undergoing the sex change. It is essential that a male/ female who wants to get their sex changed should have lived as their identified sex for at least 2 years in society. So, if a male is involved, he should have lived like a female in society for the said time and vice-versa. He will need to address himself as she, a female to his parents, friends, in his college or workplace.

Note: Usually, most individuals come to realize that they are transsexual and want to get a sex reassignment operation around the second or third stage of puberty - which ranges between 12 to 13 years of ages. Diagnosis for the surgery is usually done after these stages.

Psychological Certification

Dr Richie Gupta, “Surgeries are only a part of the treatment, the most important thing for the patient is the correct diagnosis. Diagnosis of the condition during which other things are ruled out like psychiatric disease before the surgery. For instance, a case of female to a male patient is there, so the psychiatrist will meet the family, friends and people at school and her workplace and sensitize them to that person, making them understand that he has different needs. Telling the patient to go live as a male in society, how to behave, etc., making them role play. They dress up and perform all tasks as their identified gender that helps them adjust. Later the psychiatrist writes a letter to the surgeon, that the patient is of sound mind, and does not have any mental illness, asking them to go forward with the hormone therapy and surgery.”

After the psychological certification of the individual as a transsexual has been done, the mental health professional will refer the patient to a surgeon.

Meeting the above-mentioned requirements qualifies an individual to get a sex change operation as per standards set by the World Professional Association for Transgender Health. They have created “seven standard of care”, in which the period of these interventions is defined after which a surgeon can go forward with the operation.

Hormone Therapy (required for sex-change operations)

Hormone therapy helps in facilitating the desired sexual role within the person naturally. Under hormone therapy, female hormones are induced inside a male transsexual and vice versa. This results in transsexual developing characteristics of their identified sex, making the female transsexual’s voice to become deeper, the growth of facial hair, fat distribution and change in muscular development, etc. Hormone therapy is delivered to the patients before their sex change operation.

Surgeries involved sex change operation in India

Male to Female Sex Change

Male to female sex change requires one surgical procedure in which female genital organs are constructed after removing the male genital organs.

Breast enlargement is performed during the second stage of the operation. As in some cases, breast enlargement might or might not be necessary after hormone therapy, as some patients can develop them naturally. Additional, breast enlargement surgery is only performed if the patients particularly ask for it.

Female to Male Sex Change

Female to male sex change requires three surgeries that include breast reduction surgery, removal of female sexual & internal organs and reconstruction to male genitals.

All these surgeries are usually performed in a span of 3 months or more. The surgeries are scheduled in intervals to allow the patient to recover after each operation.

Note: Psychiatric help is also required by patients after the procedure, to help them adjust into society.

Side Effects/ Risks of Sex Change Operation

Sex change surgery includes similar side effects to any other operation. These risks include infections and bleeding - as they are with any type of other major surgery. As such there are no severe or specific risks involved in the nature of the surgery.

Recovery after Sex Reassignment Surgery

In Female to male surgery, the patient recovers faster after the first two surgeries than the third surgery as it involves the construction of a penis that can take around 1 or more months to recover. The same goes with a male to female surgery which despite involving one procedure takes a month to recover because of the involvement of construction of female internal and sexual organs.

Can a patient get pregnant after sex reassignment surgery?

After successful sex change surgeries, patients become capable of indulging in sexual intercourse with the opposite sex. However, this doesn’t mean that they can get pregnant. Transsexual patients can’t become biological parents. This is due to the lack of ovaries and testes in transsexual patients, which makes them incapable of becoming biological parents. But this can be resolved with the provision of ovum or sperm preservation before the surgery. Thus, they can use it along with the latest fertility methods like a test tube baby etc., to become half-biological parents.

The reason why they can’t become pregnant is because of the default chromosome structure of the patients, that doesn’t allow it. However, researchers are working to make it possible one day.

Sex change surgery doesn’t pose a risk on the life of the patient

Sex change operations don’t involve any grave risk on the lives of the patients. This surgery is very similar to a kidney or gallbladder surgery and is much safer compared to heart surgery. Transsexuals don’t have to worry about any side-effect or risk with this operation.

Is sex change operation performed in India?

Medical tourists are drawn to India for medical treatment because of the low cost of surgery, JCI accredited hospitals, internationally trained surgeons, latest technology and state-of-the-art infrastructure.

Sex change patients are no exceptions. Yes, Sex change surgery is performed in India. Fortis Hospital in New Delhi performs 100 sex reassignment operations every year.

Sex Change Operation in India: Fortis Hospital, New Delhi

Treating Doctor: Dr Richie Gupta│ Senior Consultant of Plastic Surgery Department

Fortis Hospital, Shalimar Bagh has a multispecialty Gender Identity center that deals with Transsexual operations. They deal with a significant number of cases every year and carry out sex reassignment procedures routinely. Genital change surgery like penis removal and penile inversion removal and vaginoplasty with clitoroplasty and labiaplasty costs around USD 5000 at the hospital.

Facial feminization, breast augmentation and voice feminization, etc. are also performed at the healthcare center. The cost estimate for other surgeries involved in sex change operation in India can be given after analyzing the patient in India.

“Currently, we are taking 100 to 150 cases every year at Fortis, Shalimar Bagh. We do both, male to female and female to male sex surgery. We have a gender identity clinic, in which we have psychiatrists who are trained in gender identification, hormone specialists, psychologists, and surgeons. We have got entire team in this unit dedicated to gender affirmation operations.” added Dr Richie about the Gender Identity Clinic at Fortis Hospital.

Stay

Total Stay required in India (excluding the hospital stay ) : 4-7 weeks (depending on the final treatment plan)

The procedure requires medical tourists to receive treatment on multiple visits as it involves multiple stages (psychological evaluation, hormone therapy, and surgeries) which can extend from 15 days to a month for each visit. For Female to Male, the patient can visit India, in intervals after recovering for each of the three surgeries.

For further queries about sex change operation in India contact Medmonks.