Medicosnext
LGBT rights as fundamental rights was recognized by Nepal’s constitution and legalized in 2007 with the introduction of several new laws. With the introduction of the supportive laws, and formation of the LGBT society, citizens who once feared to express their gender freely have now come upfront to reveal their true identity. However, this is just not enough for them, as they have to go under the sharp knives of surgeons, and that too, multiple times, along with other supportive measures to achieve the bodily shape of the desired gender.
The hefty cost, unavailability of the procedure in Nepal, and persisting societal discrimination have made the seemingly easy dream project as one of the most difficult to achieve. Gender-affirming surgery, or in simple words, transforming the gender with the use of the scalpel, is all that comes to mind when we talk about gender transformation, but it includes far more than that. Transgender affirmation needs a unified approach that includes primary care, hormone replacement therapy (HRT), behavioral health support, gender-affirming surgeries, and other supportive services.
Primary care includes general healthcare needs, with routine screening and health maintenance, as well as yearly physicals and sick visits, along with specialists’ consultation when deemed.
HRT is best provided by trained endocrinologists, who sit down and discuss the risks and benefits of the therapy before starting. After that, a regimen is developed as per the patient’s requirement to maximize the effects from hormones and to keep the patient safe. Generally, there are two kinds of therapy: 1) Feminizing hormone therapy for developing more feminine appearance. These hormones help to develop breasts, change shape of the face and body, and even alter some of the body’s hair growth patterns. It includes estrogen therapy and testosterone-suppressing therapy. This therapy module is for those who are undergoing male to female (MTF) transforming procedures. 2) Masculinizing hormone therapy is to develop a more masculine appearance. It includes testosterone therapy to develop facial and body hair, along with deepening the voice, to change the shape of the face and body, and stop menstruation. This therapy is for those who are undergoing female to male (FTM) transforming procedures.
Behavioral health support includes individual counselling, support groups, psychiatric evaluations, ongoing medication management, pre-surgical evaluations, pre-and post-surgical psychotherapeutic support, and education. By knowing the individual needs and goals, the support team works to overcome anxiety, depression, post-traumatic stress disorder, and other features that may be present, so as to smoothen the whole process.
For gender-affirming surgeries, the surgeon will meet and discuss the patient’s goals and then agree on a plan for the surgery. All the necessary preparations, expected outcomes, risks and recovery process will be discussed. Physical preparations like removing hair at the genital creating area, tissue expander placement, losing weight, and quitting smoking will be undertaken before the real surgical procedures. Thus, as per the requiremen,t either trans-feminine (male to female) or trans-masculine (female to male) surgeries are carried out.
Trans-feminine surgery includes breast augmentation (inserting breast implants with optional fat grafting to create breast), facial feminization surgery (procedures to reshape the face for more female look), orchiectomy (removal of testes), vaginoplasty (creation of a vagina, clitoris, labia majora, and labia minora), and voice feminization (shorten the length of vocal cords to change a voice to higher pitch).
Trans-masculine surgery includes chest masculinization (removal of breast tissue to create a masculine chest), metoidioplasty (creation of glans or penis from the existing clitoris, along with creating scrotum from the labia majora, lengthening of urethra and closing of the vaginal opening), phalloplasty (creation of a penis), and hysterectomy (removal of the uterus and ovaries).
Transgender health does not start and end with hormones and surgery. They face a variety of issues like workplace discrimination and homelessness. Thus,supportive services like social work, spiritual care support, and legal support are needed.
