Management of gender incongruence and gender affirmation surgeries – The Indian perspective, from a large volume gender identity clinic

Abstract

A mismatch between the birth sex of a person and psychological recognition of self (gender) leads to a gender expression, which is at variance with the societal norms, and thus gives rise to a persistent distress, which is known as gender incongruence (GI) (previously gender dysphoria). These persons are known as trans genders. A subset of these individuals feels that they are trapped in the wrong sexed body and need to bring their physical sex into alignment with their gender. The “gender” is already imprinted into the brain at birth, and hence cannot be changed, but the physical sex of a person can be, through gender affirmation surgeries (GAS). There has been relative paucity of data from India regarding medical and surgical affirmative management of trans-persons, and hence, the authors present their experience in GAS together with current demography, hypothesis regarding etiology and management, as carried out in India. Authors have been providing comprehensive affirmative management to trans persons, through their multi-specialty gender identity clinic (GIC) sited in a tertiary care hospital. Over past 27 years, the senior author has performed over 3,000 GAS. The authors have noticed a 20- fold rise in presentation of these cases (from six cases per year in 1993 to now around 150 cases in the year 2019), an observation, which is similar to the experience of large volume GICs worldwide, as well as many recent publications. There has been a steep rise in the number of persons with GI worldwide, and those reporting at GICs. In the face of this rising number, authors present their experience, together with current demographics and management. Authors have also contributed to the first version of Indian Standards of Care for persons with GI and people with differences in sexual development/orientation Indian standards of care 1in November 2020.