Transitions: How India's Changing Culture Affects Transgender people and Their Care

By: Olivia Miltner
Produced and Edited By: Charlie Hatch

A group of transgender Indian women. Photo from GLAAD.

When the nurse asked her patient what she wanted to do after the operation and what name she would claim, the patient responded, “I’ll go lingerie shopping,” and “Nyra.”

Later, when she awoke after her surgery, Nyra D’souza was herse
lf.

“The first thing I heard after the surgery was, ‘Nyra, it’s over,’ and that was the most assuring statement that anyone could have ever said to me,” D’souza said.

D’souza completed gender affirmation surgery in May 2016. Now living in Mumbai, she’s one of about 490,000 transgender Indian people, according to the 2011 Indian census.

Her experience, which she described as physically and mentally difficult, reflects changing attitudes toward transgender people in India.

“I’m so happy right now,” D’souza said. “I don’t get up and say, ‘Oh damn, I have to shave today.’”

India is becoming a friendlier place for transgender people; the Indian Supreme Court recognized a third gender in 2014, and this summer, Indian politicians approved a new law that purports to further protect transgender people — though some LGBT activists are unconvinced.

However, Indian transgender communities are still stigmatized, and the conflicting sentiments toward trans people are reflected in the care they receive throughout the country.

When D’souza told her parents she wanted to go ahead with gender affirmation surgery, they told her she would have to do it alone.

“I haven’t seen much support so far,” D’souza said.

In addition to her family’s scorn, D’souza has found little help elsewhere. She included her friends in her transition process, but she said she had to actively seek their help, and she was hurt when they didn’t visit her in the hospital.

“I had to book an appointment with my friends. That’s what I realized.”

After she recovered, her friends would make degrading statements. Once, a friend said, “You need to try very hard to look like a woman because for us it’s fine; we have boobs, we have the real stuff, but for you, you have to like, get into it.”

Some people disagree with the lifestyles of LGBT community members, a sentiment reflected by Indian actress Kavita Radheshyam when she tweeted in June “Aren't #LGBT Against Nature? Whatever Is Against Nature, Shouldn't Live.”

Additionally, various religious organizations have also opposedgovernmental efforts meant to support LGBT people, particularly regarding the decriminalization of gay sex.

D’souza believes her isolation stems from upbringings that reinforce the disapproval of transgender people, and she said prejudice against transgender people, especially from families, is exacerbated when people transition from male to female.

“You always expect a son. You don’t expect a daughter,” D’souza said. “You want a male child.”

Additionally, transgender men are almost invisible. A 2015 New Delhi T.V. story attributed the lack of recognition to how transgender men “have no support system, no spaces of their own.”

The general attitude toward transgender people can range from indifference to fearful, said University of Hyderabad sociology professor Pushpesh Kumar in an email.

“Phobia might translate into violence,” Kumar said. “Trans men, if able to pass off [are] okay, but when not able to pass off could be dangerous. It also depends upon which class the transman/woman belong to.”

Devdutt Pattanaik, a bestselling author on Indian and Hindumythology, believes the conflict surrounding transgender people is, in part, a clash between modern, or Western, ideas and the traditional understandings of gender and sexuality in India.

“Society is aware of queer sexuality and comfortable as long as it is marginal,” Pattanaik said in an email. “But with modern notions of rights, and equality, and justice, that is disrupting traditional orders, there are bound to be tensions.”

A 2014 study published in the International Journal of Transgenderism found seven Indian cities had almost no male to female gender transition services in public hospitals, while “moral positions taken by health care providers might be partially accountable for the lack of gender transition services.”

Transgender women in India pose for a photo.
Picture by R Barraez D'Lucca (Flickr Common)

Despite this, some people see India as an advantageous location to undergo gender affirmation surgery, D’souza’s surgeon Sanjay Pandey said. Pandey works at a Mumbai hospital, and he said people from across Asia are attracted to India’s holistic, transparent and relatively inexpensive health care.

Within India, Pandey said transgender people have become more accepted by society, and care for those looking to transition has become more lucrative, resulting in more doctors working in the field.

“Trans care is a little missing compared to what it should be, but I’m extremely pleased looking at trans care evolving very well,” Pandey said.

However, trans people still often experience inadequate medical care, said Souvik Ghosh, who works at the Chennai-based HIV and AIDS non-profit Saathi, in an article published by the The Guardian in June.

“When they go to the government hospital ... trans people are told to leave or are treated like aliens,” Ghosh said. “Doctors will say they only serve women or men.”

Rajat Gupta, a gender affirmation surgeon at the Sushma Plastic and Cosmetic Surgery Clinic in Delhi, said emphasizing the integration of transgender peopl
e is important..

“I would recommend reservations in jobs for them, better social acceptance. Government should allocate funds for their rehabilitation,” Gupta said in an email. “The social acceptance is still a great challenge.”

In the future, Pandey hopes the threats he sees transgender people face, such as discrimination in employment, to become less common.

“Trans individuals are normal ... please don’t shun them. Please embrace them,” Pandey said.

The changes transgender advocates what to see should come from within India, rather than be externally imposed, Pattanaik said. This, he said, would “demand faith and patience and wisdom.”

After going through her transition, D’souza said other people looking to undergo gender affirmation surgery should make sure to plan ahead. She also said they should expect high medical expenses and the need for assistance, such as a maid, after the surgery.

“You need to be super self-dependent,” she said.