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Last Updated Wednesday September 18 2019 01:40 PM IST

Everyday Health | Transgenders – there is much to know before judging!

Dr Rajeev Jayadevan
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kalki-manabi-prithika-seethal-transgenders (From left) Kalki Subramaniam, a transgender rights activist, actor, writer and entrepreneur from Tamil Nadu; Manabi Mukhopadhya, a West Bengal native, who became the first transgender to become a college principal in India, Prithika from Tamil Nadu who became the first transgender police officer in India and Seethal Shyam, a known transgender activist from Kerala.

There has been much discussion on the topic of transgenders in media lately. For those who are unfamiliar with the subject, opining and acting on the issue has rather been like the case of the blind men and the elephant – each person thinks it is something else. The blind man who feels the tail of the elephant will describe the animal as a broom, while the one who feels the leg will swear that the elephant looks like a pillar. Unfortunately, society’s ignorance on this topic has caused substantial trauma and needless suffering to a lot of people.

This article is written to throw light on the transgender phenomenon, and is presented in a format that is easy to understand, starting with an explanation of basic technical terms, then describing the troubled life of a transgender, followed by a discussion on what the society can and should be doing on this subject.

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1. What is TG? (Transgender)

It is not an infrequent observation that some men prefer to dress up as women, and vice versa. While this might seem odd to those who do not know about the subject, understanding the phenomenon of Transgender will help overcome this apparent oddity and the resulting prejudice.


Technically speaking, when a healthy person, later in life, develops a gender identity and expression opposite to the sex that they were born with, they are called TG (Transgender). To understand this better, it is important to clarify two commonly used words with subtle difference in meaning: 'Gender' and 'Sexuality'

2. What is the difference between gender and sexuality?

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One's Gender depends on how he or she sees "ONESELF" as a person. Gender, which is essentially a sense of self, is considered a matter of the mind, unlike sex, which pertains to the body. Gender sense is complex, influenced by race and local culture; and is more diverse than the conventional binary (male and female) model.

Sexuality, on the other hand, refers to a person's emotional and sexual attraction towards "ANOTHER" person.

a) GENDER: Generally, human beings born with XX chromosome identify themselves as female gender, while those with XY chromosome as male gender.

However, when a healthy person later develops a gender identity opposite to his or her own biological state they are called TG (Transgender). For example, if a person with XY chromosome develops a compulsive belief that he is a woman trapped in a man's body, then he is a 'MTF' (Male to Female) TG. Likewise, when an XX person discovers that she has the mind of a man trapped in the body of a woman, she is termed a FTM (female to male) TG.

b) SEXUALITY: The majority of human beings get attracted only to the opposite sex (heterosexuality), while a significant minority (2.3 percent) naturally feel attracted to people of the same sex. This is called homosexuality, also termed gay/lesbian. Bisexual people (1.8 percent) have normal bodies and chromosomes, but feel sexually attracted to both sexes. [This is not to be confused with Intersex (see below).]

Thus, TG (transgender) and homosexuality are entirely different entities.

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Note that a TG, like anyone else, can get attracted to the opposite biological sex or, sometimes, to the same sex.

3. Are homosexuality and Transgender considered diseases that need medical cure?

No. Both are perfectly natural outcomes in a healthy body. It is neither the person's fault nor a fault of the upbringing. It is not an anomaly of local culture, as the phenomenon exists in every known society, since recorded history. They cannot and need not be medically 'treated' to change their orientation. It is not against the law either. There is no need to punish them or 'advice' them about it. What such individuals need most is empathy and social support.

4. How many TG's are there in Kerala?


An estimated 25,000 TG's live in Kerala. The vast majority are male-to-female (MTF) TG's.

5. What is the difference between transvestite and transsexual?

Transvestite (cross-dresser) is a person who dresses up as a member of the opposite sex, but without altering their body. Broadly speaking, such cross-dressing can be due to three different reasons:

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1. A person might cross-dress because they identify themselves with the opposite sex. Such a person believes that cross dressing fits their true gender identity, which happens to be different from birth. For example, a person, born as a male, decides to wear a woman’s clothing, because he believes he is a woman. This is the case for a MTF transgender.

2. A man might cross-dress as a woman for sexual gratification, knowing fully well that he is a man, and that his new dress belongs to the opposite sex.

Surya Surya, a transgender from Kerala, casts her vote in the last assembly elections. PTI

3. A man might temporarily cross dress as a woman only to perform an act of entertainment - they are called ‘drag-queens.’

It should be noted that when a person wears clothes traditionally worn by the opposite sex for the sake of convenience, it does not constitute transvestite behaviour. E.g. a woman wearing a man’s pants for convenience sake.

Thus, the majority of TG’s are cross-dressers, driven by a genuine belief that they belong to the opposite sex.

Some TG’s, in addition to being cross-dressers, wish to physically alter their bodies in the direction of the desired sex, using hormonal or surgical treatment. They are called transsexuals. For example, a person, born as a biological male, decides to undergo treatments to change his body to that of a female. This is called sex reassignment surgery (SRS).

vanitha-july Vanitha magazine features Deepti, a transgender

Incidentally, the cover page of the current issue of Vanitha magazine features Deepti, a transgender (who underwent sex-change operation from male to female), with a caption that reads: “this is history.”

6. Do all TG's go for sex reassignment surgery (SRS)?

Although all TG’s prefer to dress like the opposite sex, only few successfully undergo SRS, partly because of lack of finances and local availability of such resources.

SRS modalities for (MTF) TG include, after extensive expert counselling and hormone therapy, operations like breast augmentation, laser electrolysis to remove hair, orchiectomy, vaginoplasty and other specialized procedures.

7. What is Intersex? Is it different from TG

Unlike TG's who are born with normal anatomy and chromosomes, people with intersex conditions have abnormal anatomy or chromosome pattern from birth that is not typically male or female.

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8. What are Hijras?

Hijras are mostly male to female TG’s who live as a cult in communes along the fringes of society, having their own rituals and hierarchy. A typical Hijra household has 5-20 members who take care of one another with a meagre income. The leader is called a Naik, followed by gurus (mothers) and chelas (daughters). In northern India, they are invited by tradition to bless newborn children as well as newly wedded couples, for which a fee is charged. Many Hijras seek alms at places of worship in exchange of purported blessings. Refusing to pay a Hijra could invite unsavoury reactions of varying degree. They have been assigned the third gender status by the Supreme Court of India. Only about 8 percent of them have been castrated, so technically they are not all eunuchs.

Hijra culture is not reported in Kerala, where TG’s prefer to stay under the radar for fear of persecution. The Hijra communities of Tamil Nadu and Karnataka often provide shelter for TG’s from Kerala who’ve run away from home. Though they do receive food and shelter, these new recruits become ‘chelas’ and end up seeking alms at traffic stops or on trains, doing music and dance programs or engaging in prostitution, distributing the income by chain of command. Higher education and gainful employment are not actively promoted or attempted by many Hijra communities.

To quote a landmark Bollywood reference, Amitabh Bachchan portrayed a Hijra briefly in the 1981 movie Laawaris, when he cross-dressed as a woman to sing the hugely popular song “mere angne mein” which meant “What are you doing in my backyard?”

9. What problems do TG's face?

Mostly from society's ignorance and prejudice, TG's frequently suffer teasing, taunting, physical abuse, incest, lack of family support, and extreme ostracization. The risk of suicides among TG’s is higher than in the general population.

Many drop out of school, get disowned by parents and run away from home. They are even denied places to stay, and tend to live in their own groups where they have peer support.

Because of the social vulnerability, abuse, incomplete schooling and difficulty finding employment, and from resorting to unconventional modes of generating income, TG’s are at higher risk of many illnesses including depression, alcoholism, anxiety and sexually transmitted diseases.

Many TG’s discover their gender discrepancy in childhood, but suppress it fearing abuse. A fair number of those who disclose their new orientation will eventually suffer torture at the hands of their parents who mistakenly believe that punishing the child will change the orientation. Frequently, MTF TG’s are forced into marrying a woman, something unthinkable due to their steadfast feminine orientation. Such measures can bring on suicidal ideation.

In Kerala, a survey by the social justice department found that 51 percent of the TG’s conceal their gender identity from their family, while 78 percent conceal it at their place of work. Only 11 percent have regular jobs, and 54 percent have a monthly income of under Rs 5,000.

Several TG’s in Kerala live dual lives -- that of their birth gender by day, and of their preferred gender by night, in the company of like-minded people, where they feel safe and accepted. Some TG’s who live frustrated lives with their birth-assigned gender in an attempt to conform to society’s expectations, occasionally break free and anonymously travel to far-away places where transgender festivals are held. After spending a few days cross-dressed as a woman in the comforting company of other transgenders, they quietly return home after the event.

Against all odds, some TG’s do try to pursue higher education and employment. NGO’s and activists help TG’s emerge from the shadows and enter the mainstream.

10. Why is society reluctant to have a positive approach to TG’s?

Society at large is judgmental, relying on perception rather than facts. TG’s doing productive work are generally not noticed much by society, for various reasons: for instance, they may be not be publicly visible while working behind the scenes in fields such as catering and cosmetics. Apart from a few personalities who braved the odds like Kalki Subramainam (journalist/activist, Tamil Nadu), Madhu Bai Kinnar (first transgender mayor, Raigarh) Jaanmoni Das (celebrity makeup artist, Kerala) and Padmini Prakash (TV anchor, Tamil Nadu), the general public in India is not familiar with TG’s playing a significant role in the forefront of society. For example, there are very few TG teachers, lawyers, politicians or other public figures in India yet.

Make-up artists (Left to right) Jaanmoni Das, Renju Renjimar and Avinash Chetia - Kerala's ace make-up artists who belong to the transgender community

On the other hand, society will readily recall the antisocial public behaviour that a few TG’s exhibit as part of a desperate attempt to make a living: this creates a vicious circle of stereotyping, prejudice and marginalization.

This is one of the important reasons to bring TG’s to the mainstream and not to discriminate. The recent announcement by Kochi Metro rail promising employment for transgenders is a major step in such social progress. Once transgenders are given a chance to prove themselves publicly as productive members of society, this vicious circle can be broken, and a brighter future ensured.

11. What improvements have occurred in the system for TG's?

The Supreme Court of India, in 2012, has affirmed the constitutional rights and freedoms of transgenders. The court has protected one’s gender expression by invoking the freedom of speech and expression, asserting that “no restriction can be placed on one’s personal appearance or choice of dressing, subject to the restrictions contained in Article 19(2) of the Constitution.”

Laxmi Narayan Tripathi (First from the right) Laxmi Narayan Tripathi is the first transgender person to represent Asia Pacific in the UN in 2008.

In 2014, TG's were granted 'Third Gender' status by the Supreme Court, which directed the government to treat TG's as socially and economically backward. This broke the binary (Male-Female) status that had prevailed till then.

In 2015, Kerala became the first Indian state to introduce a TG policy, providing equal access to social and economic opportunities, resources and services, right to equal treatment under the law, right to live life without violence, and inclusion of TG as a third gender in all government-related forms. A dedicated justice board for transgenders is expected to deliver justice and equality to this marginalized group of people.

Further to the TG policy announcement, educational scholarships are available for TG’s, albeit only in a few universities such as Kerala University at this time.

12. What can the society do for TG's?

As is the case with other areas of social progress, changes at the grassroots level for TG’s will lag several years the exciting new policy announcements at the top. Awareness programs are the need of the hour -- these will help the progressive ideas percolate into the community and reduce adverse life outcomes for TG's.

Meanwhile, society must avoid taunting people for the difference in their gender or sexual preferences. Over the years, society has learned and accepted that discrimination against skin color, sex, caste, religion, etc., is wrong. It is time discriminatory thoughts and actions against TG's are discarded too. Slangs (rude local words) must be avoided – TG’s can be politely referred to as 'Transgender'.

Children must be taught by teachers to sincerely respect all their peers, regardless of all of the above differences including TG. Teasing and taunting at school and college, whether or not it is on the topic of gender -- should be prohibited. Parents should refrain from punishing their children who display alternative gender identity, as such abuse will not only be futile, but will also prevent the person from completing basic education and becoming self-reliant in the future.

Doctors, other healthcare professionals, administrative and law enforcement personnel should become more sensitive and empathetic to the medical and psychological needs of TG's, and avoid ill-informed judgmental remarks when such a person approaches for help.

And finally, TG’s themselves should become aware of their assigned rights, seize available opportunities and pursue education and employment opportunities beyond the conventional. Availing the assistance of progressive peer groups, NGO’s and the department of social justice will be the way to go.

(The author is a senior consultant gastroenterologist and deputy medical director, Sunrise group of hospitals)

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