gender reassignment surgery in pakistan

28,000 people have applied for ‘gender reassignment surgery’ in the last 3 years in Pakistan

According to reports, the Ministry of Interior has recently received numerous applications from people seeking gender reassignment surgery . The Ministry has submitted the details of applications received to the Senate for approval.

As per details, 28,723 individuals have applied for gender reassignment surgery during the incumbent government’s rule.

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Speaking to a media outlet, the interior ministry spokesperson shared why people request a sex change surgery. He said:

Citizens apply for gender reassignment due to medical reasons.

Summary of Data from 2018 to 2021

According to data provided by trusted sources, several men and women have sought approval for gender reassignment surgery from 2018 to 2021. A total of 16,530 men applied for gender reassignment (from men to women), while 12,154 women sought gender reassignment (from women to men). It should be noted that nine men applied for gender reassignment (from men to transgender), 21 transgender people requested gender reassignment (from transgender to men), and nine transgender people wanted gender reassignment (from transgender to women).

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Pakistani woman seeks court approval for sex change to earn a living

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A 22 year old Pakistani woman has petitioned the Peshawar High Court for permission to have sex reassignment surgery so that she can work publicly and support her family.

Kainat Murad told The BMJ , “I want to work and earn a livelihood for my family. I have no brothers or sisters, and my parents, who cannot work, need my support.” She said that it was difficult to venture out in public and work as a woman in Pakistan’s male dominated society.

Her lawyer, Saifullah Muhib Kakakhel told The BMJ that his client had gender dysphoria and that she suffered from depression, anxiety, and insomnia. “Her father has been suffering from paralysis for over a decade, and she is unable to earn a livelihood as a woman,” he said.

Kakakhel said that violation of women’s rights was common in Pakistan and prevented the free movement of women. “It isn’t easy for a female to go freely from home to workplace,” he said.

In a written application to the high court, Murad said that she had been living as a boy or man since childhood, played sports with boys, and wore men’s clothes. She said that women were not safe at their workplace and were sexually harassed, humiliated, and exploited. It was her constitutional right to live the life of her choice and change her sex, she said.

According to Kakakhel, Murad was extremely poor and could not afford to pay for sex reassignment surgery. She has asked the court for her surgery to be carried out in a state run hospital free of cost.

Murad claimed that she was advised by doctors to approach the high court for permission to undergo the sex reassignment surgery to prevent legal complications.

Khalid Masud, director of the Lady Reading Hospital in Peshawar, told The BMJ that the hospital was ready to carry out the surgery if the court sanctioned it.

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Home Lahore First successful transgender operation at LGH

First successful transgender operation at LGH

For the first time in the history of Lahore General Hospital, Amara, a matriculation the student was made a boy after undergoing a unique operation.

Under the supervision of the Head of the Department Plastic Surgery Dr. Roomana Ikhlaq along with assistant professors Dr. Muhammad Nasrullah Dr. Muhammad Imran completed this gender reassignment procedure after performing a complicated but successful surgery of four hours, after which the parents changed her name to Ammar. The patient was discharged from the hospital after recovery.

Principal Ameer Uddin Medical College Prof. Dr. Sardar Muhammad Al-Freed Zafar while congratulating the doctors on the first successful transgender operation through plastic surgery at LGH said that it is practical proof of their professionalism and competence which is highly admirable and commendable.

Prof. Al-freed Zafar further said that the doctors and surgeons of PGMI/LGH are not less qualified and competent than the doctors of any world-class hospital and the General Hospital is equipped with all the latest medical equipment and facilities as well to provide the best surgery facilities to all the patients.

Talking to media in this regard, Dr. Roomana Akhlaq said that Amara underwent a complete medical examination on arrival at the hospital and after various diagnostic tests in the light of which it was decided to perform the operation which was successful.

Leading Gynecologist Prof. Al-freed Zafar while answering the questions of the media said that gender reassignment is not possible in Pakistan as a fashion.

Only when the boy or girl shows signs of the opposite sex, hormonal changes and other such issues in early childhood, then the doctors check up on the patient and determine whether the sex change of the said boy or girl is necessary and due.

He said that such gender reassignment operations are being carried out in Pakistan as per requirement but not as a fashion like other countries.

The family of Ammar thanked the doctors, nurses, and paramedics for taking better care of their patient and expressed their happiness over their daughter’s change of gender.

They told that right from childhood she was showing different signs like why and by the time she reached puberty, his face had begun to grow like a man’s, and a hormonal check-up was done, which was performed by doctors at the General Hospital, who undertook this complex operation.

After the sex change, Ammar said in his talk that he is thankful to Allah Almighty and the addition of a boy in our family is a reward from nature on which everyone is happy.

He said that after this successful operation his world has changed as girls at school used to make fun of boy’s voices while my hobby was riding motorcycles, playing cricket and other sports on which people were surprised. Now I have become a boy for which I am very happy.

These moments are nothing short of a miracle for me. Ammar’s mother said that such operations cost millions of rupees in the private sector but the administration and doctors of the LGH have provided the best medical facilities free of cost. Ammar expressed that he will fulfill the responsibility of his family.

On his recovery, Ammar marked victory and thanked the doctors, nurses and paramedics who treated him very well. Dr. Abdul Aziz, Dr. Saima Fatima, Mehwish Saeed, Navera Sharif, Humera Boota and other medical staff were present on this occasion.

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Explainer: The Crucial Fight for Legal Gender Recognition

In many parts of the world, transgender people are still denied the right to have their gender identity legally recognized or are forced to make impossible choices between full participation in society and other basic human rights. But many countries have also seen recent advances in legal gender recognition, an important area of transgender rights. Let’s examine the signs of positive change and explore why these technical procedures are so important. 

What is Legal Gender Recognition?  

Legal gender recognition (LGR) allows transgender and gender-diverse people to change their sex/gender marker and names on official identity documents. Inconsistencies between a person's identified gender and official documentation often create barriers that can limit a person's access to health, education, employment, and public services. 

Why is LGR important for democracy?  

In short, LGR plays a fundamental role in ensuring that all individuals are treated equally under the law, regardless of their gender identity. LGR can affirm the individual’s right to self-identification and bodily autonomy, while the lack of LGR creates barriers exposing transgender and non-binary individuals to exclusion from full societal participation and to significant amounts of discrimination and violence in various areas of life. For example, conflicts in the voter register may create obstacles to exercising the right to vote, exacerbated by increasingly strict voter identity laws in some places. 

Controversially, the process of LGR often includes requirements that constitute human rights violations , including compulsory medical treatments, genital surgery, and sterilizations. These interventions are often costly and arbitrary, and they infringe on one’s right to physical integrity and in some cases procreative freedom.

Where and how is LGR made available? 

Laws vary considerably in different countries and localities as to how transgender people can have their legal identity documents changed, as shown in The International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA) map . ( Click the map below to view a larger version .)

What types of approaches are used to enable (or in some cases restrict) LGR?  

What are some good practices from around the world .

Civil society activism is driving progress in Europe. In Georgia, a transgender woman was first able to change her gender on official documents in 2021, following years of advocacy by queer and women’s rights groups, yet the prerequisites remain costly and invasive, requiring sex reassignment surgery. 

Malta passed landmark legislation in 2015 protecting against medical interventions and introducing self-determination, making it a first-mover in Europe, despite resistance from the Catholic Archdiocese of Malta  for potentially imposing a “new definition of sexuality and gender.” The law was passed as part of a package of legal reforms expanding transgender rights after a case was brought by a transgender activist to the European Court of Human Rights.  

Asia and the Pacific:  

Hong Kong ’s top court ruled on 9 February 2023 that full sex reassignment surgery is no longer required for people seeking LGR. LGBTQIA+ activists hope the ruling influences neighboring Asian countries.  

South Asian countries like Pakistan , India and Nepal have taken great strides on legal LGBTQIA+ issues. In 2018, Pakistan passed a historic bill allowing people to have their self-perceived gender recognized on all official documents.   

New Zealand passed a landmark self-identification law on 9 December 2021, allowing people to change gender markers without requiring any medical or legal procedures. Within Oceania, New Zealand and Australia both offer the option to have one’s gender listed as “unspecified” in official documents.  

Africa and Western Asia:   

South Africa is considered one of the most progressive countries in Africa on LGBTQIA+ legal issues. Transgender people have been able to attain LGR since 2003, although obstacles remain, such as the requirement for medical treatments (hormonal) before getting LGR approval. 

Israel has significantly eased the process of changing gender markers on identity cards over the past several years. Until 2015, gender reassignment surgery was required, but as of 2020, the Justice Ministry approved new rules that removed this demand, as well as the need for hormone replacement therapy. 

South America is advanced in terms of self-determination for official documents, procedures for which are currently in place in Argentina , Brazil , Uruguay , Colombia and Ecuador .  

A 2018 ruling by the Inter-American Court of Human Rights found the right to update official documents to conform to a person’s gender identity to be protected under the American Convention on Human Rights, and required states to institute domestic LGR procedures. A February 2022 judgment by El Salvador’s Supreme Court has since urged the passage of reforms to allow LGR.  

In Honduras, President Xiomara Castro has committed to establishing LGR procedures after the Inter-American Court of Human Rights found Honduras responsible for the killing of transgender activist Vicky Hernández in 2021.

What are the latest LGR developments in 2023?  

International IDEA’s Democracy Tracker recently highlighted the following developments:  

What are some common concerns for LGR applicants around the world? 

Medical mandates: Sterilisation requirements remain prevalent across the globe. The LGR procedures of 13 European countries retain mandatory sterilisation, despite a 2017 European Court of Human Rights ruling that the requirement represents a human rights violation. Other restrictions persist as well, such as having to undergo sex reassignment surgery, which is required in China, Taiwan, Singapore, and South Korea. The uptake of self-determination also remains limited: Only nine European countries allow for individuals to change their gender identity based on their own declaration.  

Criminalization: Several countries in the world, most notably in Central Asia, Western Asia, East Africa and North Africa, criminalize LGBTQIA+ people’s very existence and lack LGR frameworks altogether. In March, for example, the Ugandan parliament passed a bill that would criminalize identifying as LGBTQIA+.  

Other requirements: In some countries—including 19 out of 46 Council of Europe member states—married transgender people are required to divorce if they want to access LGR.

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Gender reassignment surgery remains successful in Lahore

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LAHORE: A teen with indeterminate sex underwent successful gender-change surgery in Lahore to become a male, ARY News reported on Friday.

13-year-old Kinza, named Abdullah after the procedure, was operated by a specialist surgeon Dr Afzal Shaikh in Pakistan’s first-ever dedicated centre for treatment of indeterminate sex.

Kinza was provided free-of-cost treatment at the centre built in Aghaz Trust Hospital in Punjab’s provincial capital.

Talking about the case, Dr Shaikh said Kinza was diagnosed with indeterminate sex eight months ago.

“Abdullah will be kept under observation at the centre for some time,” Shaikh said.

Earlier in March 2018, a girl had approached the Islamabad High Court (IHC) and sought its permission to undergo sex-change surgery.

The girl, through her lawyer, submitted before a bench that she had been experiencing physical changes in her body and she was advised to undergo a gender reassignment surgery.

The petitioner had also prayed to direct the National Database and Registration Authority (Nadra) record and other government departments to change her gender in her identity documents.

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Deconstructing Transgender Identities in Pakistan, India, and Iran in Colonial and Post-colonial Context

• Thematic Section
• Published: 24 January 2020
• Volume 63 , pages 31–37, ( 2020 )

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This article examines rights-based mobilization amongst the transgender community in Pakistan, India, and Iran. It tackles the dominant discourse of Human Rights, which has always found its geographic epistemic in the Global North. Thus, it argues that understanding the rights of transgender people in a non - Western world requires tracing the etymological history of such rights language, which is embedded within a greater vernacular knowledge of rights influenced by its colonial past.

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Interrogating the Gaze of Normativity: A Study of Transgender Women in West Bengal

Transgender in a Global Frame

Traditional Genders, Modern Sexualities: Struggles over Sexual and Gender Nonconformity in Postcolonial India

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Harassed, intimidated, abused: but now Pakistan's hijra transgender minority finds its voice

Down a grimy alleyway in Rawalpindi, in the heart of Pakistan's military establishment, a striking figure tweaked her makeup and squirted a dash of perfume under her arms.

Life as a hijra , as Pakistan's ­transgender minority is known, can be tough, said 21-year-old Alisha, recounting tales of extortion, sexual violence and predatory policemen. But of late things have started to improve.

The government has offered help, the hijras' plight has come into the public eye, and even the police are showing a little respect.

"They call us the chief justice's darlings," she said.

An unlikely revolution is stirring among Pakistan's transgender community. Over the past six months the supreme court has issued a series of ground-breaking judgments in favour of hijras, who have long lived under a cloud of disapprobation and ­discrimination.

Spurred by the forceful chief justice, Iftikhar Chaudhry, who was restored after countrywide protests last year, normally moribund authorities have been ordered to ensure hijras enjoy the same rights as other Pakistanis, in matters of inheritance, employment and election registration.

Police have been warned to cease harassment and intimidation. Pakistan's national database and registration authority, which issues ID cards, has been told to research a third option under the "sex" column.

"Times are changing," said Almas Bobby, leader of one of the largest group of hijras in Rawalpindi. "Our community feels good for the first time in 60 years."

The changes have triggered a heady sense of possibility.

In October hijras in the southern city of Sukkur fielded the country's first hijras cricket team. After winning their inaugural match, the captain thanked the chief justice.

The exuberance is spreading. Earlier this month about 100 hijras from across Punjab crammed into a tented rooftop area for a raucous dance party.

Showers of rose petals filled the air as hijras of all ages, draped in sequined dresses and bedecked in costume jewellery, danced into the small hours – whirling and swinging their hips in the manner of Bollywood movie stars.

The hijras' roots run deep in Asia: many were respected courtesans in the courts of the Moghul emperors who ruled south Asia in the 17th and 18th centuries. One even commanded troops into battle.

But behind the merriment, hijra life can be lonely and dangerous in a conservative society such as Pakistan.

Most hijras describe themselves as "professional wedding dancers" (women performers are forbidden under Pakistani law) but campaigners say their main sources of income hail from begging and prostitution.

Alisha, who worked as a makeup artist to pay for silicon implants, sported a 36B bra under a red sequinned dress. "I've always felt like a girl in my soul," she said. But her voice also rang with sadness: her middle-class Islamabad family cast her out. She pointed to Azeem, a middle-aged hijra who once worked as head of ­housekeeping in a five-star hotel.

"Now she is my mother and father," Alisha said.

Although often referred to as "eunuchs", many of Pakistan's hijras have not undergone gender reassignment surgery, according to campaigners. The medical and psychological services available in other Asian countries, such as Thailand, are either absent or operate in the shadows. A plastic surgeon in Rawalpindi, speaking on condition of anonymity, said he would only operate on hijras after hours.

"It would not raise the prestige of the clinic if they were seen," he said.

The surgeon said he also treated a minority of women seeking gender ­reassignment surgery.

"They come in with bandages on their breasts, which causes ulcers and lesions, threatening to commit ­suicide if we don't operate," he said.

Back at the party in Rawalpindi a group of men wearing regular shalwar kameez , loose trousers and tunic, watched from the back of the room. They were the "sponsors" – often married men who keep hijras as mistresses.

The men watched silently, filming with their mobile phones, but sometimes stepped forward to cast bundles of 10 rupee notes over their favourite dancers – and in so doing, sent banknote images of Muhammad Ali Jinnah, Pakistan's founding father, fluttering to the ground.

An unlikely revolutionary

The man leading the hijras ' modern crusade is an unlikely warrior: a lawyer who specialises in Islamic law. Islamabad barrister Muhammad Aslam Khaki instigated the supreme court cases last year after reading about a brutal incident in Taxila, near the capital, where police allegedly robbed and raped a group of eight hijra wedding dancers.

"People don't consider them as human beings. They don't like to eat with them, drink with them or shake their hands," he said. "But they are full citizens of Pakistan like everyone else."

It is not the first time the softly-spoken lawyer has challenged Pakistan's status quo. Last year Khaki persuaded a federal Islamic court to overturn the punishment for drinking alcohol – 40 lashes of the whip – on the basis that it was not in accordance with the Qur'an. Later, he won a declaration that prisoners should be allowed conjugal rights with their wives during visiting hours – also, he says, a little-known provision of Islam.

"Ours is the most misunderstood religion," he said.

But his advocacy for hijras is a bridge too far for some. He has received death threats from Shabab e-Milli , an offshoot of the youth wing of Pakistan's main religious party, Jamaat e-Islami. "They say I am protecting the gay culture. But I am protecting them from the police culture of torture and sex abuse." Declan Walsh

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Between a Rock and a Hard Place – Gender Dysphoria and Comorbid Depression in a Young, Low-Income, Pakistani Transgender Man

Usama irshad.

1 Internal Medicine, King Edward Medical University/Mayo Hospital, Lahore, PAK

Ali Madeeh Hashmi

2 Psychiatry, King Edward Medical University/Mayo Hospital, Lahore, PAK

Gender dysphoria (GD) describes an incongruence between a person's assigned and expressed gender and the distress associated with it. The management of GD ideally involves a team of healthcare professionals, including psychiatrists, endocrinologists, and surgeons, and may include one or more of the following - psychotherapy, hormone therapy, and gender reassignment surgeries. While Pakistan still has a sizeable population of the traditional 'khwaja siras' or 'hijras,' many young transgender Pakistanis are now adopting global transgender identities and seeking sex-reassignment procedures from a state-run healthcare system, which still heavily discriminates against them. In spite of the passage of a new law protecting the fundamental human rights of transgendered Pakistanis, they continue to be oppressed and deprived of education, employment, and healthcare. This case report describes one such young transman from a low-income Pakistani household, who, owing to the legal red tape, family pressure, religious disapproval, and hefty hospital expenses, is left with only two options - to undergo unsafe, unstandardized procedures at the hands of quacks or live the rest of his life trapped in the wrong body. There is a dire need for a wide-scale awareness campaign to educate and sensitize the general public about transgender rights. Medical students must also be exposed to transgender patients during their medical school training in order to familiarize them with the special medical needs of transgender individuals.

Introduction

Gender dysphoria(GD) is a new addition to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, replacing the previously used term gender identity disorder (GID) . It is defined as a marked incongruence between one’s experienced/expressed gender and assigned gender, of at least six months’ duration as manifested by at least two of the following - marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics, a strong desire to be rid of one’s primary and/or secondary sex characteristics, a strong desire for the primary and/or secondary sex characteristics of the other gender, a strong desire to be of the other gender, a strong desire to be treated as the other gender, and a strong conviction that one has the typical feelings and reactions of the other gender [ 1 ].

Pakistan is a country in South Asia with a population exceeding 212.2 million people [ 2 ]. The state religion is Sunni Islam. Discrimination and disapproval of the lesbian, gay, bisexual, and transgender (LGBT) community, and the associated social stigma, mostly stem from religious beliefs [ 3 - 4 ].

The term ‘transgender’ has different connotations in Pakistani society [ 5 ]. It usually refers to a group of individuals locally known as ‘hijras’ or ‘khwaja siras’ who do not conform to the traditional gender binaries and are widely thought to possess mystical powers. They are invited to sing and dance on occasions like the birth of a male child or a wedding and are supposed to bring good luck. Hijras live in close-knit communities or ‘addas’ formed along the lines of a ‘guru-chela’ relationship dating back to the master-disciple relationship in Sufism and speak a cryptic language called ‘Hijra Farsi’ [ 5 ].

In present-day Pakistan, owing to increasing westernization, many young, non-binary, and transgender individuals are breaking away from this traditional system and adopting a global transgender identity. Owing to increasing, albeit reluctant, parental acceptance, many of them opt to stay with their biological parents [ 6 ]. In 2018, Pakistan’s Parliament passed the Transgender Persons (Protection of Rights) Act, which, at least on paper, gives every individual the right to have their self-perceived gender identity on all national identification documents and protects the rights of transgender individuals to education, healthcare, and equal employment opportunities [ 7 ].

In spite of legal and constitutional protections, transgender individuals continue to face discrimination in accessing medical services, education, housing, transportation, and livelihood opportunities [ 8 - 9 ]. They have been subjected to widespread familial and societal violence, gang-raped, and murdered in cases that have been prominently highlighted in the local and international media [ 10 - 11 ].

In healthcare facilities, transgender individuals face harassment and are often turned away mainly because of the health professional’s ignorance and lack of experience in treating patients who do not conform to the strict gender binaries of the Pakistani society [ 12 ]. Across Pakistan, there is no inclusion of transgender healthcare issues in the medical education curriculum. Additionally, doctors are hesitant to perform any gender-reassignment procedures, hormonal or surgical, for fear of religious and legal repercussions. At present, a court order is required to be able to perform a gender reassignment surgery in Pakistan [ 13 ].

Gender dysphoric individuals in Pakistan from the upper and middle classes have the financial freedom of traveling to countries like Thailand for sex-reassignment surgeries in safe, private hospital settings, often without their families ever knowing about it [ 14 ]. But low-income individuals with limited education and financial freedom do not have this option. Consequently, they are faced with two equally grim possibilities. Many of them, fearing endless legal battles, harassment at healthcare facilities, and hefty hospital expenses, end up taking poorly regulated hormones and becoming victims of dangerous surgical procedures performed by quacks behind closed doors. This leads to medical complications and disfigurement. The remaining half spend the rest of their lives consumed by the constant mental distress of ‘being trapped in the wrong body.’ A vast majority of these individuals suffer from anxiety and depression compounded by hatred, stigmatization, and discrimination on a day-to-day basis.

Case presentation

A 25-year-old, South Asian assigned-female-at-birth (AFAB) and self-identifying as male with preferred pronouns he/him, presented to us in the outpatient clinic of the psychiatry department with the chief complaints of low mood, suicidal ideations, anxiety, and a desire to change his sex. The fifth of seven siblings, he was born and brought up abroad in an Arab country where his father was a blue-collar worker. As a child, he would dress up as a boy, accompany his father to his workplace, play with cars, and would angrily burn any dolls gifted to him by relatives and friends. He attended a co-educational school up to fifth grade where he got romantically involved with a girl, to the ire of his mother and the school principal. His father was deported to Pakistan when our patient was 12 years old. He and his siblings were stranded abroad for five years with their mother, who had to do odd jobs to make ends meet. He had to drop out of school and developed symptoms of major depression with suicidal ideations during this time. The family finally managed to come back to Pakistan.

His father, who he shared a good relationship with and who would fondly encourage him to dress up as a boy, died two years after the family's arrival in Pakistan. The siblings, along with their mother, now live with an unwelcoming paternal family and do odd jobs to sustain themselves. Our patient, who has always been sexually attracted to women, is currently in a romantic relationship with a female cousin and wants to marry her. They have been kissing but have not yet had sexual intercourse. He practices breast binding and has a strong aversion for his female-specific body parts. He has frequent conflicts with his family because of his lifestyle and suffers from a low mood and suicidal ideations. He denied any specific suicidal plans or intents during his interviews with us. His mother and sisters strongly disapprove of his desire to undergo sex-reassignment while his two younger brothers are supportive of his choice.

During his interviews with us, we found him to be friendly and extroverted, displaying a strong desire to be able to live, dress, and move around like a man. He wants to eventually be able to marry his female cousin, build a home, and have a family. He is a practicing Muslim and reads books on religion besides enjoying poetry, movies, singing, and playing the guitar. He described himself as a pragmatic person who likes to weigh the pros and cons of every decision.

The patient did not have any prior medical or surgical history, including any prior hospital admissions, and did not take any medications. He was born via a normal spontaneous vaginal delivery (SVD) in a hospital and had normal early development. He was playful and energetic as a child and had no neurotic traits or physical illnesses while growing up. He occasionally smokes cigarettes from the age of 14 years. He attained menarche at 14 years of age, has regular periods lasting two to three days with scant blood flow. He was unable to finish his formal high school education after fifth grade and works in a factory for a meager monthly income of a few thousand Pakistani rupees.

On examination, he appeared of his stated age and androgynous, with a slim build. Patchy hair loss was noted in the parietal and occipital regions. The rest of the physical examination was unremarkable. Apart from a dysthymic effect, his mental status examination was unremarkable.

Investigations

The patient was admitted to the inpatient floor of the psychiatry department for medical and psychological evaluation. His vitals were within normal limits. A baseline profile was ordered (including complete blood count (CBC), liver function tests (LFTs), renal function tests (RFTs), and serum electrolytes), which came out to be within normal limits. A gynecology consult was made for a complete gynecological examination, including abdominal and pelvic ultrasound, which was reported to be normal for a female of our patient’s age group. Hormonal levels, including luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, prolactin, and thyroid function tests (TFTs) were also ordered and came out to be within the physiological range for a female of his age group.

Differential diagnosis

Detailed psychological assessment was done to rule out body delusion, transvestism, or female homosexuality.

The patient was diagnosed with gender dysphoria with comorbid depression and escitalopram 10 mg by mouth, once daily, was started along with daily psychological therapy. He was advised to express himself according to his desired gender during these sessions and was also educated about the standard requirement of having to live as a person of the desired gender in the society for at least six months before any sex reassignment procedures could be initiated. The possible societal, emotional, and legal challenges associated with sex reassignment surgeries in Pakistan were described in detail. Endocrinology consult was called to comment about future hormonal therapy options, but they refused to comment fearing the legal repercussions of any such intervention.

Outcome and follow-up

During his two week stay in the hospital, our patient was under immense pressure from his family, especially his mother who was vehemently opposed to any form of sex-reassignment procedures for religious reasons. After a fortnight of medical and psychological therapy, he was sent home and advised to follow up in the outpatient clinic weekly for the next six months while continuing to live as a man at home and at work. He, however, subsequently failed to follow up with us, citing clashing work hours, familial resistance, and a lack of financial independence as the main reasons.

The reporting of this case is of utmost significance because, on a global level, transgender health remains a neglected and under-studied subject [ 15 ]. It will be the first case of female-to-male gender dysphoria from Pakistan to be reported in the literature. To date, only two cases of male-to-female gender dysphoria (previously gender identity disorder) from Pakistan have been reported [ 16 - 17 ].

The reporting of this case is also significant because no effort has been made in earlier case reports on gender dysphoria from Pakistan to acknowledge or use the patients’ preferred pronouns. Given the increasing global awareness around the proper use of preferred pronouns, we have taken great care to always use the patient's preferred pronouns and gender identity throughout this case report.

This report is also significant because it will also be the first case report on this subject from Pakistan after the DSM-5's recoining of the previously used term gender identity disorder as gender dysphoria (to better emphasize the fact that it is the distress from being trapped in the wrong body that is pathological and not the feeling itself).

Socioeconomic factors are very important determinants of the final outcome in gender dysphoria patients, and existing case reports from Pakistan do not make any reference to the socioeconomic status of their patients. Therefore, it is imperative to report this case because it details the impact of socioeconomic determinants on the final outcomes in gender dysphoria patients in low-income, Muslim, Pakistani households.

Conclusions

It is imperative to expose medical students to transgender individuals during the course of their education and to teach them about the unique physical and mental health needs of transgendered bodies. At the same time, serious discourse must also begin among Pakistani medical and legal experts, as well as human rights activists, about court requisitions for sex-reassignment surgeries and whether such a prerequisite negates the fundamental right of a capable, adult human being to be able to make decisions about their own body. There is a dire need for a wide-scale social awareness campaign on national television and print and social media in order to educate the general public about the discrimination, hatred, and violence traditionally faced by transgender individuals. At the same time, parents of transgender children must be educated about the importance of providing their children unconditional love and emotional support to help them grow into strong, independent individuals.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained by all participants in this study

Today's Paper | April 24, 2024

Ji seeks formation of medical board to recommend gender change instead of 'self-perceived identity'.

The Jamaat-i-Islami (JI) on Monday presented a bill in the Senate seeking an amendment in the Transgender Persons (Protection of Rights) Act, 2018, for the creation of a medical board that would recommend whether a person's gender should change, instead of them seeking a reassignment on the basis of their personal identity.

The law , in its current state, reads: "A person recognised as transgender ... shall have [the] right to get himself or herself registered as per self-perceived gender identity with all government departments including, but not limited to, Nadra (National Database and Registration Authority)."

Opposing this provision, the amendment bill presented by Senator Mushtaq Ahmad calls for the formation of a gender reassigment board to suggest to Nadra whether a person's gender should be reassigned.

It recommends the formation of such boards at the district level after the approval of the prime minister and provincial chief ministers, with each board comprising a professor doctor, a psychologist, a male general surgeon, a female general surgeon, and a chief medical officer.

The proposed law seeks a prohibition of gender reassignment surgeries or any other treatment to change genital features on the basis of "any psychological disorder or gender dysphoria". It also states that the law in its present form could lead to the "legalisation of homosexual marriages".

Read: Being transgender — facts, myths and rights

Arguing that the current law violates the dignity of Muslim women, it further states that deeming gender identity a personal matter is contrary to the teachings of Islam.

As Senator Ahmad presented the bill in the upper house, he too contended that under the current law, a person could get themselves registered as a man or a woman not on the basis of their biology but their "personal thoughts".

Quoting interior ministry data that stated that around 28,000 cases of gender change were processed over the past three years, he said Nadra had been changing people's genders following a mere request by them.

This form of the law, he argued, was against the Holy Quran and Sunnah.

Opposing the bill, Human Rights Minister Shireen Mazari said the proposed amendment was aimed at "victimising" transgender persons as the current law gave them the right to identity.

"Till date, not a single complaint has been received regarding the misuse of this [existing] law," she added.

JI and Jamiat Ulema-i-Islam-Fazl senators protested Mazari's remarks, following which Senate Chairman Sadiq Sanjrani sent the bill to the relevant standing committee for discussion.

Gender reassigment cases over 3 years

During last week's Senate session , Senator Ahmad had sought information about the total number of applications received for issuance of gender change certificates by Nadra from July 2018 to June 2021, with original and intended gender-wise breakup of the applicants.

In a written reply to the question, Interior Minister Sheikh Rashid Ahmad said gender change certificates were not issued by Nadra. However, he said, gender was modified due to medical reasons or on submission of an application.

According to data shared with the house, 16,530 cases of gender change from male to female were processed, 12,154 cases of female to male, 21 cases of transgender to male, nine cases of male to transgender and as many cases of transgender to female.

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Medindia » News » Research News » A Global Comparison: Best Countries for Gender Reassignment Surgery

A Global Comparison: Best Countries for Gender Reassignment Surgery

Purpose and Procedures

Chest surgery (top surgery) for ftm transitions:, phalloplasty for ftm transitions:, breast augmentation for mtf transitions:, facial feminization surgery (ffs) for mtf transitions:, vaginoplasty for mtf transitions:.

Turkey Emerges as a Budget-Friendly Destination

Latin america offers competitive prices.

Belgium: Affordable and Progressive in Europe

The u.s.: highest costs and legal challenges.

• Expert Q&A: Gender Dysphoria - (https://www.psychiatry.org/patients-families/gender-dysphoria/expert-q-and-a)

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When is it permissible to do a sex-change operation from male to female or vice versa?

Publication : 04-12-2014

Views : 147330

Praise be to Allah.

Firstly: 

It is not possible for anyone, no matter who he is, to change the creation of Allah, may He be exalted, from male to female or vice versa. Whoever Allah, may He be exalted, has created as a male can never become a female who menstruates and gives birth! 

Yes, the doctors may tamper with him to satisfy his perversion so that he will think that he has become a woman, but he will never be truly female and will live in a state of anxiety and worry, which may lead him to commit suicide. 

Secondly: 

What a person may feel in his mind and heart, that he is of a gender other than what he appears to be to us does not give him an excuse to change his gender; rather it comes under the heading of following the Shaytaan in changing the creation of Allah – outwardly but not truly – and those feelings do not make it permissible for him to undergo surgery or take medicines and hormones to change his outward appearance. Rather he must be content with the decree of Allah, may He be exalted, and treat his case on the basis of faith and obedience to Allah. It is not permissible for him to make himself appear outwardly to be of a gender other than his real gender with which Allah created him, otherwise he will be committing a major sin; if this person is really female then she will be masculinised and if he is really male then he will be effeminate. 

Please see also the answers to questions no. 21277 and 34553  

The surgery that is permissible in such cases is if a person was originally created male or female, but his genital organs are hidden. In that case it is permissible to do surgery in order to make those organs appear, and to give him or her medicine or hormones to strengthen the characteristics with which Allah originally created him or her. 

But in the case of one who was created with both female and male genitalia – this is what is called ambiguous intersex – it is not permissible to be hasty in removing one and making the other more apparent. Rather we should wait until it is known what Allah, may He be exalted, will decree for this individual, which may become apparent after some time has passed. 

For a more detailed discussion on intersex please see the answer to question no. 114670  

There follows a detailed fatwa from the scholars of the Standing Committee for Issuing Fatwas, who were asked about a case similar to what is mentioned in the question. They replied: 

Firstly: Allah, may He be exalted, says (interpretation of the meaning): “To Allah belongs the kingdom of the heavens and the earth. He creates what He wills. He bestows female (offspring) upon whom He wills, and bestows male (offspring) upon whom He wills. Or He bestows both males and females, and He renders barren whom He wills. Verily, He is the All-Knower and is Able to do all things” [ash-Shoora 42:49].  So the Muslim must accept and be content with whatever Allah creates and decrees. 

In your case, if you are as you mentioned, that you are certain of your masculinity and that you can play the male role efficiently, even if you have not actually engaged in any sexual activity with any person, then you must preserve your masculinity and accept that which Allah has granted to you of virtue and a favourable situation. . 

Secondly: once your masculinity is proven and established, then having surgery to turn into a female – as you think – is changing the creation of Allah, and is an expression of discontent on your part with what Allah has chosen for you, even if we assume that the surgery is going to be successful and lead to what you want of becoming female. But there is no way that it can be successful, for both males and females have their own, distinct faculties and physical makeup, the development and characteristics of which are decreed only by Allah, may He be exalted, and are not just the penis of the male or the vaginal opening of the female. Rather the man has a complete, integrated system comprising the testicles and other organs, each of which has a special function and characteristics, and produces specific secretions and so on. Likewise the woman has a uterus and other connected parts that work in harmony with it, and each part has its own function and characteristics, and produces specific secretions and so on. Among all of them there are connections and harmony over which none of His creation have any power of estimation, creation, control, management or preservation. Rather all of that is under the control of Allah, the All-Knowing, Most Wise, Most High, Almighty, Most Kind and All-Aware. 

Therefore the surgery that you want to do is a kind of tampering and striving for something in which there is no benefit. In fact it may be dangerous; if it does not lead to death, then at the very least it will lead to taking away that which Allah has given you without you attaining what you want, and you will still be affected by what you have mentioned of psychological problems that you want to get rid of by means of this surgery that is bound to fail. 

Thirdly: if your masculinity is not established, and you only think that you are a man because of what you see in your body of outward masculine appearance, in contrast to what you feel in yourself of having feminine characteristics and an inclination towards males and being sexually attracted to them, then you should examine your situation and not go ahead with the surgery that you have mentioned. You should consult experienced specialist doctors. If they determine that you are male in outward appearance but are in fact female, then you may submit yourself to their treatment, so that they can bring out your femininity by doing surgery. But that will not in fact be a sex change from male to female, because this will not be up to them; rather it will be bringing out your true nature and removing what is in your body, and what you feel deep inside you of confusion and ambiguity. But if nothing is clear to the experts, then do not take the risk of undergoing this surgery; be content with the decree of Allah and be patient with what has befallen you, seeking to please your Lord and protecting yourself against the possible consequences of doing an operation without guidance and insight concerning your condition. Turn to Allah and beseech Him to relieve you of what you are facing, and to heal you from your psychological problems, for control of all things is in His hand, may He be glorified, and He is able to do all things. End quote. 

Shaykh ‘Abd al-‘Azeez ibn Baaz, Shaykh ‘Abd ar-Razzaaq ‘Afeefi, Shaykh ‘Abdullah ibn Qa‘ood, Shaykh ‘Abdullah ibn Ghadyaan 

Fataawa al-Lajnah ad-Daa’imah (25/45-49) 

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A Franklin County judge on Tuesday temporarily blocked an impending law that would restrict medical care for transgender minors in Ohio.

The decision came weeks after the American Civil Liberties Union filed a lawsuit challenging House Bill 68 on behalf of two transgender girls and their families. The measure prevents doctors from prescribing hormones, puberty blockers or gender reassignment surgery before patients turn 18.

Attorneys contend the law violates the state Constitution , which gives Ohioans the right to choose their health care.

"Today's ruling is a victory for transgender Ohioans and their families," said Harper Seldin, staff attorney for the ACLU. "Ohio's ban is an openly discriminatory breach of the rights of transgender youth and their parents alike and presents a real danger to the same young people it claims to protect."

House Bill 68 was set to take effect April 24 after House and Senate Republicans  voted to override  Gov. Mike DeWine's veto. Proponents of the bill contend it will protect children, but critics say decisions about transition care should be left to families and their medical providers.

The suit in Ohio mirrors efforts in other states to challenge laws that restrict gender-affirming care for minors. A federal judge struck down a  similar policy in Arkansas , arguing it violates the constitutional rights of transgender youth and their families. The state is appealing that decision.

“This is just the first page of the book,” Attorney General Dave Yost said Monday. “We will fight vigorously to defend this properly enacted statute, which protects our children from irrevocable adult decisions. I am confident that this law will be upheld.”

What does House Bill 68 do?

House Bill 68 allows Ohioans younger than 18 who already receiving hormones or puberty blockers to continue, as long as doctors determine stopping the prescription would cause harm. Critics say that's not enough to protect current patients because health care providers could be wary of legal consequences.

The legislation does not ban talk therapy, but it requires mental health providers to get permission from at least one parent or guardian to diagnose and treat gender dysphoria.

The bill also bans transgender girls and women from playing on female sports teams in high school and college. It doesn't specify how schools would verify an athlete's gender if it's called into question. Players and their families can sue if they believe they lost an opportunity because of a transgender athlete.

The lawsuit doesn't specifically challenge the athlete ban. But it argues that House Bill 68 flouts the constitution's single-subject rule, which requires legislation to address only one topic. House Republicans introduced separate bills on gender-affirming care and transgender athletes before  combining them into one .

In Tuesday's decision, Franklin County Judge Michael Holbrook indicated that the law could be tossed out because of a single-subject violation.

"It is not lost upon this Court that the General Assembly was unable to pass the (Saving Ohio Adolescents from Experimentation) portion of the Act separately, and it was only upon logrolling in the Saving Women’s Sports provisions that it was able to pass," Holbrook wrote.

Panel clears ban on gender reassignment surgery for minors

Tuesday's decision came one day after a legislative panel cleared the way for an administrative rule that will ban gender reassignment surgery for minors. Ohio health care providers say they do not perform that procedure on patients under 18.

The rule will take effect May 3.

The measure was among several that DeWine proposed to regulate gender-affirming care after he vetoed House Bill 68. In testimony for Monday's meeting, opponents argued that the rules overstep the administration's authority and conflict with federal law.

"The proposed administrative rule changes are based on biased definitions, ignore well-established best practices and restrict countless patients’ access to gender-affirming care," said Mallory Golski, civic engagement and advocacy manager for Kaleidoscope Youth Center.

DeWine's other proposals are still working their way through the rulemaking process. That includes a requirement for transgender minors to undergo at least six months of counseling before further treatment occurs. Another rule would require providers to report non-identifying data on gender dysphoria diagnoses and treatment.

Haley BeMiller is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.