THEY feel that they are women trapped in a man's body. So they
seek the scalpel to change their sex. But do they know what they're
doing? At least two thought so.
One killed herself when her relationship with a man broke down.
Another plunged into depression because she could not cope with
life as a woman. A session with psychiatrists before they changed
their sex could have solved the confusion.
But no, the two are among a growing number of transsexuals who are
avoiding psychiatric counselling by heading to Bangkok to have
their operations done.
Singapore psychiatrist Tsoi Wing Foo has counselled 1,000
transsexuals since 1973 to see if they are ready for sex-change
operations. In the past 10 years, however, the 70-year-old
grandfatherly man with thick, black-rimmed glasses hasn't
counselled any male transsexuals (those who are born male and want
to be women). And he sees an average of only one female transsexual
a month. He's not alone in his concern.
CHEAPER, TOO
Psychiatrist Lionel Lim has seen only four transsexuals in the last
four years, compared to one to two a month previously. And Dr Simon
Siew, also a psychiatrist, has not seen any in the past year.
Why? There are a few reasons. One is that many male transsexuals go
to Bangkok for the operation, where it's often pay up, few
questions asked, snip, and take the flight home. It's cheaper by
half and faster. Transsexuals say a male-to-female operation in
Bangkok would cost between $3,000 and $6,000, while the same
operation here would cost double that figure.
Ms Amy Tashiana, a 37-year-old transsexual, was undergoing a few
sessions with a Singapore psychiatrist 15 years ago when told that
a Bangkok operation would cost half as much, without the need for
psychiatric assessment. The show promoter and entertainer packed
her bags at once. She said: 'In Bangkok, you just make an
appointment with a doctor, give the money and that's all they need
to operate on you. 'That's what happened to me. I just told the
doctor what I wanted, snip snip and voila, I woke up a
woman.'
But it isn't just a question of money. The worry is that for some
haste can lead to regret, depression and in extreme cases, suicide.
Dr Tsoi said: 'Many of them would not have gone through a
psychiatric assessment before the operation. 'Many think that the
operation is a miracle that can change them from a male to a female
and vice versa. 'But the operation doesn't transform them into the
opposite sex; it only allows them to be registered as their chosen
gender. 'If they've not (adjusted) to their lives as the opposite
sex before the operation, they're not suitable for the operation.
'Counselling is to make them realise they are the ones who make
themselves men or women, not the op.'
Certainly, Ms Amy is worried about the consequences when fellow
transsexuals are not properly counselled before opting for the
operation.
NOT TRANSSEXUALS
'Some of them are not transsexuals,' she said. 'They may be
transvestites or gays who opt for the operation to get boyfriends,
or they may do it for money (by prostituting themselves). 'They see
how easy it is for us (male) transsexuals to get men and so go for
the operation which they later regret.' Ms Amy has seen one friend
take her life after her boyfriend left her, and another slip into
deep because she couldn't adjust to life as a woman. Neither had
received counselling before the operation.
Psychiatrists in Singapore require transsexuals to live and dress
as a member of the opposite sex for at least a year before allowing
a patient to go through with the operation. Half of those Dr Tsoi
sees are not deemed suitable for the operation. He added that the
counselling sessions also help to make transsexuals aware of the
difficulties they might face after they've gone through with the
operation.
One transsexual, freelance writer Leona Lo, 28, was told to be
prepared to face discrimination. She said: 'I was very much
prompted to get a Masters degree after talking to my doctor. 'The
doctor told me that I was in for a difficult time and I had to be
twice as good as other people if I wanted to be accepted.'
POSTGRADUATE DEGREE
Ms Lo graduated with a Masters in Sociology from the University of
York in 2001, four years after going through her sex-change op.
Transsexuals interviewed said that there was a real shortage of
information here. They get information on the surgery from their
friends or the Internet - not from any official channels.
The National University Hospital's Gender Identity Clinic (GIC) is
the only facility for sex-change operations here. Since 1971, when
the late Professor S S Ratnam performed Singapore's first
sex-change operation, there have been 500 such procedures. That's
an average of 17 a year. But the GIC has done no male-to-female
operations since 2001. Since September 2001, it has done only four
female-to-male operations.
The New Paper on Sunday could not find any information on the GIC
on NUH's website, and we were unable to speak to the current
consultant, Dr Ilan Cheran.
When asked about the GIC's services, an NUH spokesman replied: 'The
NUH Gender Identity Clinic reopened in September 2001 to provide a
service to those who request it."
SERVED PURPOSE
'Thus far, the clinic has served its purpose well.' Dr C
Anandakumar, who was the specialist-in-charge at the GIC until
2001, recounted how, during his time, consultations with
transsexuals could only be done on Saturdays and after office
hours, as NUH had very little interest in encouraging sex-change
operations. Transsexuals would also need to book themselves into
single wards after the operation as Dr Anandakumar claimed 'the
hospital did not want the transsexuals to mix with other patients'.
This would push up the cost of the operation, prompting many
transsexuals to head to Bangkok for more affordable treatment. This
may have changed.
ALL IMPORTANT
An NUH spokesperson said, in reply to queries from The New Paper on
Sunday: 'All our patients are important to us and we care for them
with respect and sensitivity due to any individual. 'The Gender
Identity Clinic operates at the usual hours, as per all other
hospital clinics. Patients stay in single room as per MOH
regulation since the seventies.'
Ms Lo, 28, had her psychiatric assessment here but the operation
was done in Bangkok. She felt the lack of inforation about the
services provided by the GIC deterred transsexuals like herself
from having the operation done here.
'Many of us can't be bothered to find out more about the GIC as
it's so secretive about its services. 'It signals the clinic is not
interested in helping and is ashamed of us. There's always the
Bangkok and the surgeons there have done so many operations. The
more operations they perform, the better they get. So we're happy
to go there.' But not all transsexuals are flocking to Thailand.
Female transsexuals are still seeking help from the GIC.
MORE COMPLEX
Such operations are more complex and cost $15,000 or more here. But
Dr Tsoi believes many female transsexuals will head to Bangkok as
well once the operation is available there.
Some regrets, but she goes on with life
SHE confided in a friend that she may have regretted going for a
sex-change operation. But she told The New Paper on Sunday that
there was no point wallowing in regret. 'I have to go on with my
life,' said Nur Sarafina Mustafa. The 29-year-old freelance make-up
artist went to Bangkok for an operation that transformed her
physically into a woman. She did not feel she needed a psychiatric
assessment before the operation. Neither did the surgeon who
performed her operation require one of her. But Ms Sarafina has
found that life can be quite daunting after the operation.
Her relationships with men have not been smooth sailing so far. She
broke up with her first boyfriend as she could not bear to see him
fight with his parents over her. His parents never approved the
relationship even though the pair had known each other since
secondary school. He also paid for her sex-change operation in
1995. She broke up with her second boyfriend last year as he wanted
a woman who could bear children. Such bitter experiences have left
her questioning the operation she had, especially when her own
parents cannot accept her as she is now.
'My parents disowned me after I told them I went for the operation.
They thought I had disgraced them,' she said. She's tried calling
her parents since then but their reply is always a terse 'We don't
have a child like you' before the line goes dead. Asked whether
going for counselling sessions would have prepared her for the
difficulties she has encountered after the operation, Ms Sarafina
replied: 'I didn't think of that.'
COMMON MISCONCEPTIONS
TRANSSEXUALS are often mistakenly grouped with transvestites. But
the terms are not synonymous. A transsexual is someone who has a
persistent desire to surgically and legally change his/her gender.
A transsexual feels a strong need to alter the body to match the
inner self. Transvestites do not dislike their genitals or want to
get rid of or change them. Transvestites are always male while
transsexuals can be of either sex. Transsexuals cross-dress to
conform with the inner self. Transvestites cross-dress (as women)
to get sexual satisfaction.
The biggest misconception that people have about transsexuals is
that they choose to be the way they are. Psychiatrist Tsoi Wing Foo
said: 'People need to understand that transsexualism is an inborn
condition and not a sexual perversion.' He admitted he did not
think transsexuals should be operated on when he entered the field
in 1973, but changed his mind as he learnt more about them.
Dr Tsoi said: 'My negative feeling about transsexuals was due to
ignorance and lack of exposure to them. 'But as I went deeper into
the field, I found that they cannot live the lives of the sex they
have been born into. 'As one patient told me, 'Who wants to pay
money to have their sex organs taken off?', it's not something that
they can help.'