On the first Tuesday of every month, an ordinary-looking clinic at the busy Government Medical College, Kottayam, transforms into a progressive, first-of-its-kind medical kiosk for a few hours. A team of five doctors, all specialists in separate fields, cater exclusively to the medical needs of members of the transgender community.
“We’ve all had a few transgender people as patients in our regular OP schedules. But they will not openly admit to being transgender,” says Varghese Punnoose, Professor and Head of Department (HOD), Psychiatry. The usual ritual of standing in a queue, sitting with other patients and their families—who often tend to stare—and getting shouted at by the staff takes a toll on their morale. By the time they get to the doctor, they are clearly in distress.
Usually, it is a simple cosmetic change—removal of facial hair being the most common—they want, which most skincare clinics offer. It’s followed by breast augmentation. Both are common treatments, on offer for everyone, but the difficulty begins after this, says Sue Ann, Assistant Professor, General Medicine, who heads the team.
A complex process
To initiate the process of getting a sexual reassignment surgery (SRS), the patient must first go through multiple counselling sessions.
“My protocol is to first make them psychologically ready for a role change. I take into account their acute social isolation, possibly abusive sexual history, and depressive disorders. They need complete support and affirmation to lead the rest of their lives as a person from the opposite gender,” says Dr. Punnoose.
It can take years of psychiatric and medical follow-up before that final decision is made to go through with SRS , says P.K Jabbar, Professor and HOD, Endocrinology. “We are talking about removing the uterus, the ovaries, breasts and implanting male genitals, or removing the testis and creating an artificial vagina.”
The waiting period can be up to three or four years. SRS can only take place only after prolonged hormone replacement therapy, which entails hormone tablets and injections taken under medical supervision. “We cannot make them bankrupt either—a blood test to check oestrogen/ testosterone levels is itself costly and cannot be administered routinely,” explains says Dr Jabbar.
A plastic surgeon or an endocrinologist cannot make on-the-spot decisions about surgery or hormonal treatment without talking to a general medicine practitioner and a psychiatrist. In case of SRS, urologists and gynaecologists also need to be consulted.
Transgender persons sometimes tend to self-medicate under peer pressure. Over-the-counter pills to enhance breasts and stunt hair growth are plenty, and contraceptive pills allegedly are a common substitute for hormone tablets. “Our main concern is to discourage such practices and improve their quality of life,” says Lekshmi Jayakumar, Professor and HOD, Plastic Surgery.
Making a choice
Geethu, 28, has lined up for SRS at the transgender clinic. She has been on oestrogen tablets since 2013—the result of excessive Googling and over-the-phone diagnosis. One of the side effects is low blood pressure. “But I’m not too worried about that. I only need to eat on time and drink lots of water.” She has become taller, her hair and breasts have grown, and unwanted hair growth has reduced. She hopes the new clinic will rope in experts once she is ready for a gender change. A classical dancer, she earns around ₹12,000 a month. Her hormone tablets already cost her ₹2,500 per month. She hopes that private donations and loans from friends will fund her surgery.
Geethu, a classical dancer
“I need to fulfil responsibilities that are far more important than changing my sexual organs,” she says. “My parents depend on me for an income. It could be the only reason they haven’t thrown me out of the house.” Leya is more than happy with her impending laser treatment for hair removal (₹800 to ₹ 2,000 per sitting at a government clinic, ₹20,000 if private) and breast enhancement surgery (₹25,000 approximately at government clinics, ₹1 lakh if private)
At the clinic, the five-member medical team checks the patients for regular ailments and prescribes routine blood tests. A prospective SRS patient turns out to have diabetes. Another gets help for candidiasis, while his friend is diagnosed with urinary tract infection.
The difference is in the approach. The patients are not treated as aberrations. There are no sniggers, there is no staring.
The clinic is still in the trial phase. As A. Nijas, secretary, district legal services authority, which collaborated on this project with the Government Medical College, says, “We need the latest medical equipment, a separate building, more doctors.” There are no guidelines yet for granting legal immunity to these doctors, although a written consent from an adult patient is legally binding.
Kerala’s transgender population is approximately 40,000, with Kottayam accounting for 392. Most work in the entertainment industry. Healthcare is an obvious need. “But we cannot wait for solutions forever,” says Dr. Punnoose. “Somebody has to start somewhere.”
The writer lives in Kottayam, is married to a coffee planter, and happily flouts the Syrian Christian conventions of cooking and baking.
Published - July 15, 2017 04:07 pm IST
