Ekta Sonawane

Pallavi Prasad

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Anubha Bhonsle

Series Editor

Priyanka Borar

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The first time 18-year-old Sumit (name
changed) went to a government district hospital in Rohtak, Haryana to inquire
about a chest reconstruction surgery, he was told he would have to be admitted
as a burn patient.A lie. Needed to cut through the red tape that
surrounds the complex medico-legal journey India’s transgender community has to
take if they choose to transition from the body they were born in, into a body
they can feel comfortable in. Even so, the lie didn’t work.It would take Sumit eight more years of
paperwork, endless psychological evaluations and medical consultations – not to mention over one
lakh rupees including loans – to move ahead. The strained familial relationships during this trying time did not help. His dislike for his former breasts was finally dealt with by a ‘top surgery’, as
it is colloquially referred to, at a private hospital in Hisar, about 100
kilometres from Rohtak. A year and a half later, 26-year-old Sumit still hunches his shoulders when he
walks; a habit from his pre-surgery years, when his breasts were a source of
shame and uneasiness.There’s no recent count of how many people
in India, like Sumit, identify with a different gender than what they were
assigned at birth. A study in collaboration with the National Human Rights
Commission, puts the number of transgender persons in India at <a href="https://ruralindiaonline.org/en/library/resource/study-on-human-rights-of-transgender-as-a-third-gender/#section02">4.88
lakh</a> in 2017.







In the 2014 National Legal Services Authority v. Union of India <a href="https://translaw.clpr.org.in/case-law/nalsa-third-gender-identity/">case</a>,
the Supreme Court passed a landmark judgement, recognising the “third gender”
and their right to identify with their “self-identified” gender, and directing
governments’ to ensure healthcare for them. Five years later, the <a href="https://translaw.clpr.org.in/legislation/transgender-persons-protection-of-rights-act-2019/">Transgender
Persons (Protection of Rights) Act, 2019</a>
re-emphasised the role of governments in providing holistic healthcare services
to the community such as gender-affirming surgeries, hormone therapy, and
mental health services.

In the years prior to these legislative
changes, many trans persons were denied a chance to undergo gender-affirming surgery (GAS),
which may include facial surgery, and ‘top’ or ‘bottom’ surgery, involving
procedures on the chest or genitalia.Sumit was one of those who could not avail
such a surgery, for eight long years and even after 2019.Born as a female to a Dalit family in
Haryana’s Rohtak district, Sumit was a parental figure of sorts to his three siblings.
Sumit’s father, a first-generation government job holder in the family mostly
stayed away. His parents had a strained relationship. His grandparents, daily wage agricultural
labourers died when Sumit was very young. The substantial domestic
responsibilities that fell on Sumit aligned with people’s perception of the
eldest daughter of the house fulfilling caregiving duties. But it didn’t align
with Sumit’s identity. “I fulfilled all those responsibilities as a man,” he
says.Even as a three-year-old, Sumit remembers
feeling a sense of anxiety when wearing frocks. Thankfully, Haryana’s sports
culture offered some respite; it is common for girls to be dressed in neutral,
and even masculine, sporty clothes. “I always wore what I wanted while growing
up. Even before my [top] surgery, I lived as a man,” Sumit says, but adds that
something still felt amiss.By 13, Sumit began harbouring a strong
desire for his physical body to align with how he felt – boy. “I had a lean
body and hardly any breast tissue. But that was enough to feel disgusted,” he
says. Beyond the feeling, Sumit had no information that could explain his
dysphoria (unease a person may have because of a mismatch between their
biological sex and their gender identity).A friend came to the rescue.Sumit lived in a rented house with his
family at the time and had become friends with the owner’s daughter. She had
internet access and helped him find information about the chest surgery he was
seeking. Slowly, Sumit found community at school with other trans boys who
experienced varying levels of dysphoria. The young teenager spent the next few
years gathering information online and from friends, before mustering up the
courage to go to a hospital.













It was 2014. Sumit, 18, had just completed
Class 12 from a girls’ school near his house. His father had left for work,
mother was not at home. With no one to stop, question or support him, he walked
to the Rohtak District Hospital alone and hesitantly enquired about a breast
removal procedure.

Many things about the response he received
stand out.He was told he could get breast
reconstruction surgery as a burn patient. It is not unusual for procedures that
require plastic surgery to be routed through the burns department at government
hospitals, including in road accident cases. But Sumit was explicitly asked to
lie on paper and register as a burn patient, making no mention of the surgery
he actually wanted. He was also told he wouldn’t have to pay any money at all –
even though no rule prescribes such a waiver for breast reconstruction surgery or
any burn-related surgery in government hospitals.This was reason and hope enough for Sumit
to spend the next one and a half years in-and-out of the hospital, during which
time he realised there was a different kind of cost – a psychological one – to
pay.“The doctors were very judgemental
[there]. They would call me delusional, and say things like ‘why do you want to
get surgery?’ and ‘you can stay with any female you want just like this.’ I
used to feel intimidated by six-seven [of them] bombarding me with questions,”
Sumit recalls.“I remember filling forms with 500-700
questions, two-three times.” The questions pertain to the patient’s medical and
family history, psychological state, and addictions, if any. But for young
Sumit, they felt like a dismissal. “They didn’t understand that I wasn’t happy
in my body, that’s why I wanted the top surgery,” he concludes.Lack of empathy aside, there was – and
remains to a large extent – a gap in medical skills required to support India’s
trans community, should they choose to undergo gender-affirmative surgeries (GAS).While a male-to-female GAS typically
involves two major surgeries (breast implants and vaginoplasty), a
female-to-male transition entails a more complex series of seven major
surgeries. The first of these, upper body or ‘top’ surgery involves chest reconstruction
or breast removal. 













“When I was a student [around 2012], the
[medical] syllabus did not even mention such procedures. Our plastics syllabus
had some penile reconstructive procedures, [but] in the context of injuries and
accidents. But now things have changed,” Dr. Bheem Singh Nanda, Vice Chairman
of the plastic surgery department at Sir Ganga Ram Hospital in New Delhi
recalls.

04-14-ES-Sumits_journey_to_meet_himself.jpg

A milestone was the <a href="https://ruralindiaonline.org/en/library/resource/the-transgender-persons-protection-of-rights-act-2019/">2019
Transgender Persons Act</a>, which called for
a review of the medical curriculum and research that caters to transgender
persons. But nearly five years later, there have been no large-scale efforts
from the government to make GAS accessible and affordable to the Indian
transgender community. Government hospitals, too, have largely stayed away from GAS.The options for trans men are particularly
limited. The SRS in their case requires extremely skilled professionals
including a gynaecologist, urologist and a reconstructive plastic surgeon.
“There are too few medical professionals with training and expertise in this
area, and even fewer in government hospitals,” says Karthik Bittu Kondiah, a
trans man and activist from the Telangana Hijra Intersex Transgender Samiti.Equally dismal is the state of public
mental health services for trans persons. Beyond a tool to cope day-to-day,
counselling is a legal requirement before any gender-affirming procedures.
Trans people need to get a Gender Identity Disorder certificate and an
assessment report from psychologists or psychiatrists confirming that they are
eligible. This criteria includes informed consent, duration of living as
affirmed gender, level of gender dysphoria, age requirements and a thorough
mental health assessment as a guarantee of sanity. The process can span from a
minimum of one session to a maximum of four sessions, once a week with a
psychologist or psychiatrist.A decade after the 2014 Supreme Court
judgement, there is consensus in the community that inclusive, empathetic
mental health services, whether to cope day-to-day or to begin sex transition
journeys is critical, but remains a pipe dream. “My counselling for top surgery at the
district hospital went on for nearly two years.” Sumit says. Eventually,
somewhere in 2016, he stopped going. “After a point you get exhausted.”The drive to affirm his gender overpowered
his exhaustion. Sumit took it upon himself to research more about how he felt,
whether it was a common experience, what GAS entailed and where in India he
could avail one.











All this done secretly, as he was still
living with his family. He started working as a henna artist and a tailor, and
saving a some of his income for the top surgery he was determined to get.

In 2022, Sumit tried again, traveling more
than a hundred kilometres from Rohtak to Haryana’s Hisar district with a friend
– also a trans man. The private psychologist he met finished his counselling in
two sessions, charged him 2,300 rupees and told him he was eligible for top
surgery within the next two weeks.He was admitted for four days at a private
hospital in Hisar, and was billed around one lakh rupees for his stay, including
the surgery. “The doctors and other staff were very kind and humble. It was a
completely different experience from what I went through at the government
hospital,” Sumit says.This high note was short-lived.In a small town like Rohtak, a top surgery
is as close to ‘coming out of the closet’ as it gets for most people belonging
to the LGBTQIA+ community. Sumit’s secret was now clear as day, and it was one
his family couldn’t come to terms with. A few days after the surgery, when he
returned to his home in Rohtak, he found his belongings thrown outside. “My
family just asked me to leave, without any financial or emotional support. They
didn’t care about my condition.” Even though Sumit was legally still a woman after
the top surgery, concerns about potential property claims started coming up.
“Some even suggested I should get to work and fulfil the responsibilities
expected of a man.”After a GAS, patients are advised to slow
down for a few months, and preferably live near the hospital, in case of
complications. This adds to the financial and logistical burden on trans
persons, particularly those from low-income or marginalised backgrounds. In
Sumit’s case, it would take him Rs. 700 and three hours to travel to and from
Hisar each time. He made this trip at least ten times.Following top surgeries, patients also
have to wrap tight garments known as binders around their chest. “In India’s
hot climate, and given how [most] patients don’t have air conditioning,
[people] prefer getting the surgery in winter,” Dr Bheem Singh Nanda explains,
adding that sweat increases the chances of infection around the surgical
stitches.Sumit got his surgery and was thrown out
of his home in north India’s blistering May heat. “[The weeks after] were
painful, like someone has scoped my bones. The binder made it difficult to
move,” he recalls. “I wanted to rent a place without hiding my trans identity
but I was rejected by six landlords. I couldn’t rest for even a month after my
surgery,” Sumit says. Nine days after his top surgery and four days after his
parents threw him out of their house, Sumit moved into a two-room independent
house, without having to lie about who he was.













Today, Sumit is a henna artist, tailor, an
assistant at a tea shop and a gig-based manual labourer in Rohtak. He is barely
making ends meet on the Rs 5-7,000 he makes a month, bulk of which goes into
paying rent, food expenses, bills for cooking gas and electricity and debt. Of
the one lakh rupees that Sumit paid to get a chest he could look down at without
disgust, Rs. 30,000 came from the money he saved between 2016-2022. He had
borrowed the remaining Rs. 70,000 from money lenders at five per cent interest,
and some from friends.

In January 2024, Sumit still had a debt of
Rs. 90,000 which accrues an interest of Rs. 4,000 each month. “I don’t
understand how to cover living expenses and debt interests in the little amount
I earn. I don’t get regular work,” Sumit calculates. His nearly decade-long
arduous, isolating and expensive transition journey has taken a toll, leaving
him with anxiety and sleepless nights. “I feel suffocated these days. Whenever
I am alone in the house, I feel anxious, scared and lonely. It wasn’t like this
before.”His family members – who resumed talking
to him a year after they threw him out – help him with money sometimes, if he
asks for it.Sumit is not an out-and-proud trans man –
a privilege for most in India, let alone a Dalit man. The fear of being
exposed, labelled as ‘not a real man’ haunts him. Without breasts, it’s easier
for him to take up odd manual jobs, but not having other visible masculine
markers, like facial hair or a deep voice, often makes him the subject of
suspicious glares. As does his birth name – which he is yet to legally change.He’s not ready yet for hormone replacement
therapy; he’s unsure about its side effects. “But I will do it once I am
financially stable,” Sumit says.He’s taking it one step at a time.Six months after his top surgery, Sumit
registered as a trans man with the Ministry of Social Justice and Empowerment,
which also allotted him a nationally recognised transgender certificate and
identity card. Among the services now available to him is a scheme, Support for
Marginalised Individuals for Livelihood and Enterprise (<a href="https://socialjustice.gov.in/public/ckeditor/upload/SMILE%20Guidelines_1649742207.pdf">SMILE</a>),
which brings gender affirming services for transgender people under India’s
flagship <a href="https://pib.gov.in/PressReleaseIframePage.aspx?PRID=1982757">Ayushman
Bharat health insurance scheme</a>.











“I don’t know yet what other surgeries I
need for a complete transition,” Sumit says. “I will do them slowly. I’ll
[also] change my name in all documents. This is just the beginning.”The story is part of a nationwide reporting project focusing on social, institutional and structural barriers to care for survivors of Sexual and Gender-Based violence (SGBV) in India. It is part of a Doctors Without Borders India supported initiative. The names of the survivors and family members have been changed to protect their identity.

Sumit’s journey to meet himself

سُمِت کی خود شناسی کا سفر

తనను తాను కలుసుకునేందుకు సుమిత్ చేసిన ప్రయాణం

தன்னை அடையாளம் காண்பதற்கான சுமித்தின் பயணம்

ਆਪੇ ਦੀ ਤਲਾਸ਼ ਵਿੱਚ ਭਟਕਦਾ ਸੁਮਿਤ

ନିଜର ପରିଚୟ ଖୋଜୁଛନ୍ତି ସୁମିତ୍‌

प्रवास स्‍वतःच्‍या शोधाचा

സ്വയം കണ്ടെത്താനുള്ള സുമിത്തിന്റെ യാത്ര

ತನ್ನದೇ ಗುರುತಿನ ಹುಡುಕಾಟದಲ್ಲಿ ಸುಮಿತ್‌

સુમિતની સ્વ સુધી પહોંચવાની સફર

ट्रांस मरद के अपन चिन्हारी बनाय के रद्दा

एगो ट्रांस मरद के अपना के पहिचाने के यात्रा

স্বারূপ্যের সন্ধানে সুমিত

সুমিতৰ নিজকে বিচাৰি পোৱাৰ যাত্ৰা

ख़ुद की तलाश में मुब्तला सुमित

 Rohtak

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Sumit’s journey to meet himself

Sexual and gender-based violence can manifest in many forms. From familial resistance to endless medico-legal red tape, Sumit has traversed an arduous journey to reclaim his gender identity, and he has miles to go

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