Socially conservative India is attracting a stream of Americans and Europeans looking for sex reassignment surgeries. Hospitals are providing everything from world class service to post op sightseeing visits to the Taj Mahal.
Late last year when Olympian and reality TV personality Bruce Jenner transitioned to Caitlyn Jenner, she became the poster child for America’s transgender community. The media reported that Jenner underwent plastic surgeries, including facial feminization and breast augmentation, which brought into forefront the often, encapsulated realities of the transgender world.
While recent reports of her contemplating to go back to being Bruce again may give fodder to skeptics, for many of those struggling with gender identity issues,her predicament reflects the conflicting roller coaster life of a transgender person.
According to recent federal and state data, 1.4 million adults in the U.S. identify themselves as transgender. While this translates to just 0.6 percent of the U.S. adult population, the number is double the previous estimate only a few years earlier.
Growing awareness, coupled with celebrities, such as Jenner and actress and reality TV star Laverne Cox, championing the cause of the trans population are likely reasons behind the increasing willingness of people to embrace their transgender identity.
India counted its transgender population for the first time in the 2011 Census, which recorded 490,000 transgenders. Trans activists, estimate the actual number to be six to seven times higher.
In recent years the number of transgender people opting for Sex or Gender Reassignment Surgery (SRS or GRS) in the United States has been growing. While it’s difficult to estimate the number of people undergoing SRSes each year, as most procedures are done in private facilities, which are not obligated to report data, the numbers are likely in the hundreds.
SRS is a surgical procedure in which a transgender person’s anatomical appearance and the functions of existing sexual parts are altered to resemble that of a gender they mentally identify with.
In a surprising twist, a number of transgender Americans are opting to travel halfway across the world to India for gender reassignment surgery.
Ironically, India is far more socially conservative than other Western countries on transgender issues.
But that didn’t stop Betty Ann Archer, a 64-year-old American from Arizona, who flew to Delhi for sex change surgery. Born Dale Archer, she felt that it was the most exhilarating and important trip of her lifetime. Dr Narendra Kaushik, who performed the surgery on Archer, says: “In the past 3-4 years an increasingly large number of patients from Western countries are coming to India for SRSes. I see patients from UK, Australia, Brazil, London and USA regularly.”
Dr Kaushik’s facility, Olmec Cosmetic Surgery Centre in North Delhi, is a premier transgender surgery institute in India. The center provides everything for sex change surgery, from psychiatric evaluation to post–op care. For visiting patients from abroad, they throw in concierge services that include airport transfers, stay and even a post operation tourist visit to the Taj Mahal. In a thoughtful Indian touch, Dr Kaushik added that his center has a practice of gifting every male to female transitioned patient a sari to celebrate her new life.
Lower surgical costs are main drivers attracting foreign transgender patients to India. Clinics in Indian metro cities, such as Delhi and Mumbai, say that they see an average of 4-5 patients monthly from America and Europe.
In the United States, costs for a typical gender reassignment surgery run between $10,000-$24,000 for male to female reassignment and $50,000-$100,000 for female to male reassignment. By contrast in India a full transition may cost between Rs 10-12 lakhs ($15,000-$18,000). The primary procedure runs around Rs 3.5 lakhs ($5,500). Services such as breast augmentation may cost Rs 1.5 lakhs ($2,000) and facial feminization between Rs 1-4 lakhs ($1,500-$6,000).
For American Betty Ann Archer, the entire treatment cost $6,000, almost a fifth of what she estimates it would have cost her in the United States.
Pulkit Sharma, a leading clinical psychologists and psychoanalyst in Delhi, says: “The fact that Westerners are coming to India for such a private procedure is ironical in an amusing way. On the one hand, we have medical professionals who are exceptionally skilled at their work and equipped to handle such complicated procedures. On the other hand, a societal apathy towards such conditions still exists. Even amongst the physicians.”
Sharma, who offers psychological help to people suffering from identity issues, admits that amongst his Indian patients the ones who approach a psychologist or a psychiatrist are from privileged backgrounds. For a majority of the trans population in India both the means and the awareness are limited.
Dr Anup Dhir, president of the Indian Association of Aesthetic Plastic Surgeons, says: “Unlike their Western counterpart, most Indian trans people do not want to undergo a total change of their private parts. Some just want removal or construction of breast, reduction of hair, etc., only.”
Dr Kaushik disputes the popular notion that transgenders in India are deterred from the surgery because of costs: “The major problem is awareness not money.”
Dhir said that Thailand and Singapore are the biggest hubs for sex change services: “Usually people who want to travel for medical tourism look for places within 2-8 hours of flying time. USA is a bit far for many to consider coming all the way.”
The process for complete gender reassignment is long and complicated. The World Professional Association for Transgender Health (WPATH) recommends one year of hormone treatment for the surgery. The hormone therapy is meant to tilt the patients internal chemical balance in favor of their preferred gender.
Dr Kaushik says, “A lot of people from the West come to us for reconstructive surgeries too. Many are victims of botched up aesthetic surgeries.”
Long waiting periods in their home country also prod some patients to turn to India. Dr Kaushik said that that in the United Kingdom, where National Health Service covers reassignment surgery, the waiting period can run 12 years. In New Zealand, which has an acute shortage of practicing sex change surgeons, patients are sent abroad and the waiting period can be as long as 40 years.
INDIA A UNIQUE TRANS CULTURE
Contrary to popular perception, those who work closely with the trans community maintain that India can offer a safe familial atmosphere for visiting transgenders. Kalki Subramaniam, a transgender activist and artist from India, underwent GRS a decade ago in India at a clinic she would not disclose.
She says: “The beautiful thing about India is that here transgender people form a strong artificial family. They have strong network and family like bonds with each other.... The hijra culture, as it is called in India, is a strong family structure. The guru chella bond is just like a mother son bond and people who follow it are fiercely protective. Life inside the hijra community is full of strict discipline, where there is defined hierarchy and elders are respected. Sadly, this 2,000 year old tradition has been abused lately.”
Those who work closely with trans people say that American and European LGBT groups are fascinated by India’s hijra tradition. Dr Kaushik says, “The subcontinent is the only place in the world where transgender have formed a community within community.”
A TABOO NO MORE?
It may appear particularly perplexing that transgender Americans are turning to India for their medical services, given the country’s notoriously biased treatment of its own transgender population.
The Indian census data revealed significantly lower literacy rates amongst the third gender — 46 percent, against 74 percent nationally — as well as lower employment rates — 38 percent, compared to 46 percent for the general population.
The Union Cabinet of India in July approved the Transgender Persons (Protection of Rights) Bill 2016, which attempts to destigmatize and prohibit discrimination and abuse against transgenders. Nevertheless, the transgender community is one of the most marginalized in the country, compared to their counterparts in countries, such as the United States.
Pres. Barack Obama has issued an executive order prohibiting discrimination against a transgender person by the federal government and its contractors. A 2012 Human Rights study found that out of 636 U.S. companies analyzed, roughly a third provided health care coverage to their transgender employees.
On how Westerners cope with the stigma associated with transgenders in India, Dr Dhir says: “Stigmas exist everywhere. Even the Catholic school of thought has stigma. In India the stigmas are more cultural.”
Subramaniam, while acknowledging her own challenges growing up as a trans in India says: “People around the world discriminate against the third gender. Even in Thailand which is considered a haven for transgender, I have seen them discriminated.”
About her own coming out as a trans person in India, Subramaniam says: “While growing up as a woman trapped in a man’s body I was bullied and disregarded. My parents though uncomfortable with the thought were supportive and took me to a psychiatrist who himself knew precious little about transgender. I took to self-educate myself through Internet and international forums.”
Today a confident Subramaniam leads seminars and discussions on gender identity issues across India.
The trans community around the world is well knit and thanks to social media it has become easier for word to spread. Doctors say that patients with satisfactory results are bound to bring along others like them struggling to come out and lead fulfilling lives.
Sharma, the Delhi psychologist, says progress for the community will be slow: “It will be centuries before we dream that India is free from biases towards the alternate sex.”
While it may be financially a sound decision to get a surgery in India, he says, many of his Indian patients struggling with gender dysphoria chose to settle abroad as they find better acceptance there. Even as Westerner transgenders turn to physicians in India.