Mrs Doubtfire wants to be Miss India

CHENNAI: Malaika wants to be a model and win the Miss India pageant. Rose is looking for her dream man to settle down with.

Nothing unusual about these wishes except that till recently, neither would have come true. Rose, 28, an engineering student, and Malaika, 29, a hotel management graduate, were both born men.

It's only after a sex reassignment surgery (SRS) which gave them a “proper vagina instead of the ugly bulge”, that they became among the first Indians to go public about their sex change.

Sex reassignment is still new in India, but activism and awareness have prompted more people to opt for it. Mumbai sexologist Prakash Kothari says he gets five to seven queries a month about SRS, and refers two for surgery every year. “This is a large number compared to five years ago,” he adds.

“Internet-aided awareness is bringing transsexuals seeking SRS out in the open.” Sunil Keswani of Breach Candy and Wockhardt Hospitals, Mumbai, carries out at least two sex change procedures every year.

Dr Manohar Lal Sharma of Mool Chand Hospital, Delhi, says he operates on “three to four” cases every year since 2004, as against “one in two years” in the 10 years before. Chennai sexologist D Narayana Reddy says half the number of people seeking SRS in the last 25 years have been in the last three. 

With sex reassignment still largely under wraps in India — and with no medical guidelines to speak of — there are many unknown dangers. “Guidelines can only come with numbers,” says Dr Keswani.

In the US, patients are put through rigorous screening, three months of psychiatric counselling and a ‘real life test’ (RLT) for two years, where men have to dress and live like women while undergoing hormone therapy. “Only after the doctor is satisfied is the person allowed to undergo surgery,” says Dr Reddy.

Psychiatrist N Rangarajan underscores the risks: “The feeling of being a woman trapped in a man’s body, or vice versa, can also happen because of a schizophrenia-like condition. There are several instances of attempted suicides after their new identity failed to live up to their fantasies.”

While Malaika, a hotel employee, and Rose, a web developer (who were winner and runners-up in a recent transgender beauty pageant in Chennai) may be educated enough to understand the problems, thousands of transvestites in India undergo penile amputation every year at the risk of infections, even death.

In Tamil Nadu and Maharashtra — home to more than 60,000 registered transvestites — a large number go to dayammas (elderly eunuchs) for crude forms of castration. Quacks also make a killing, charging as much as Rs10,000.

The Tamil Nadu government, in a 2006 order, proposed free penile amputations for eunuchs in government hospitals, but the problems persist. “Qualified doctors are often unwilling to do the surgery, so they go to quacks,” says Lakshmi Bai, director of the Tamil Nadu AIDS Initiative (TAI).

A Cuddappah clinic in Andhra Pradesh is reportedly a hub of such undocumented, low-cost amputations. Clearly some dreams come at a heavy price. 

What is SRS?

Reconstruction of external sex organs to those of the opposite gender

Male-to-female SRS involves penile inversion — removal of testes and a part of the penis, and creation of a vagina. Surgery takes 3-4 hours

Female-to-male SRS involves removal of breasts and creating a penis-like structure.

The new 'penis' needs an implant for erection

Male-to-female surgery costs Rs1.5 lakh, while female-to-male costs Rs2.5 crore.