Kerala govt to foot the bill for sex-change surgery

Kerala to bear sex-change surgery costs
(Left) Transgender activist Sheethal Shyam said the financial assistance is a boon

Thiruvananthapuram: The state will pay for sex reassignment surgery, or genital reconstruction surgery, done by transgender persons in private hospitals in the state and outside. The maximum assistance promised is Rs 2 lakh. If more is required, the sanction of a high-level committee headed by the social justice minister is required.

"Money will not stand in the way for a transgender person who desires to live as a man or a woman," chief minister Pinarayi Vijayan said while announcing the decision in his Facebook post on August 4. The money will be paid directly to private hospitals in the state that conduct the surgery. If transpersons get the surgery done outside the state, the money will be reimbursed on the submission of bills.

Earlier, the government decision was to conduct these surgeries free of cost in government hospitals. In fact, the first such free operation was done in Thiruvananthapuram Medical College in 2017. This 'female-to-male' sex-change operation but turned out to be a messed up affair, and the patient had to be rushed to a private hospital in Mumbai. This also revealed that premium government hospitals had a lot of catching up to do in terms of sex reassignment surgery.

A sex change operation normally costs between Rs 3 lakh to Rs 7 lakh, the female-to-man operation was the more complicated procedure, and therefore, costlier. However, 99 per cent of the sex-change operations are male-to-female.

Transgender activist Sheethal Shyam said the financial assistance would be a major relief for transgender persons. “Money is the biggest issue for us. Many transpersons do sex work, and some go around begging, to find the money for the operation,” Sheethal said.

Leading transgender activist Anil Chilla said that assistance promised was good enough to cover the basic surgery costs. “For instance, a male-born wishing to live as a female can get a hormone treatment to suppress hair growth, and also a silicon implant breast, within this promised amount. The remaining operations can be done later, after mobilising enough money,” Chilla said. There are over 30 procedure invloved in the sex-reassignment surgery, right from vocal chord surgery, to hip-shortening procedures to vaginal implant.

Kerala to bear sex-change surgery costs
A sex-reassignment surgery cannot be done the next day a person expresses a wish.

Further, a sex-reassignment surgery cannot be done the next day a person expresses a wish. The transperson has to go through a two-year counselling process. “This is to assess the mental soundness of the person wanting the surgery,” Chilla said. “During the counselling, the transpersons will also be told about the devastating side-effects, like cardiac and kidney troubles, the hormone treatments can inflict on them,” he said. The treatment can also leave transpersons diabetic or hypertensive for life. “If they still want the surgery it only shows how desperate they are to lead a new life,” Chilla said.

After the counselling session starts the hormone treatment, which is a laser procedure that suppresses the hormone a transperson is born with and injects a new one (estrogen for male-borns wishing to live as females, and testosterone for women wanting to live as males). The gender transformation begins during this period. Finally, the surgery happens during which the genital reconstruction takes place.

Chilla, who had played a big role in drafting the state's Transgender Policy, said that the next step would be to introduce sex-reassignment surgery into the medical education curriculum. “Eventually, this should emerge as a major specialisation like plastic surgery,” he said.

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