Written by Ng E-Jay20 July 2008In a society like Thailand where attitudes towards transgendered people are supposedly amongst the most liberal in the world, confusion over basic issues like orchiectomy (castration) is still prevalent.
In a Straits Times article entitled "
Thai teens seeking sex changes grapple with new rule" published on 20 July 08, it is mentioned that health authorities have become alarmed by stories and the subsequent public debate about underage boys seeking and receiving castrations as the first step toward gender reassignment surgery (GRS). This concern has prompted the Thai authorities to introduce new regulation requiring people seeking GRS to be 18 or older.
To quote the ST article: "
Some gay activists and parents worried about potential side effects of the operation on bodies that are still growing believe the age at which youths can independently make the decision to be castrated should be raised to 20."
In this day and age where medical science is supposed to be undergoing rapid advancement, it is disheartening to note that unsubstantiated concerns over the effects of orchiectomy and GRS on a young person's body are still being used to justify curtailing the rights of trangendered people to achieve the crucial physical characteristic that best express their own true gender, and in so doing, live a freer and more dignified life.
There is absolutely no reason why a man seeking GRS should be prevented from undergoing orchiectomy as a preliminary procedure.
Orchiectomy, if performed when a boy is still undergoing puberty, would severely restrict the development of secondary sexual characteristics, and enable him to more easily present as a female later on in life. This is of immense psychological benefit to boys who are genuine sufferers of gender dysphoria and are seriously seeking gender reassignment.
Most of the cost incurred by a transgendered male in his quest for gender reassignment is not in the actual surgical procedure (vaginoplasty) itself, but in eliminating male secondary sexual characteristics like facial hair, and the use of hormones.
The majority of transgendered people seeking gender reassignment take estrogen to develop female secondary sexual characteristics as well as an androgen blocker to restrict the impact of testosterone on the body. These drugs might take a toll on the liver with prolonged use. Orchiectomy would enable the transgendered person to eliminate the use of androgen blockers entirely and consume far less quantities of estrogen, and yet achieve the same or even greater results.
Hence, orchiectomy not only results in substantial cost savings, but also protects the health of transgendered people.
The main concern the medical community has is that if young people are allowed to undergo gender reassignment too early in life, they may later regret their decision as they may not have had enough time to think through their decision and comprehend the consequences of gender reassignment such as sterility.
The World Professional Association for Transgender Health (WPATH) has a very comprehensive Standards of Care document which details the various medical and psychiatric protocols that medical practitioners must subscribe to when dealing with gender identity therapy. Examples of these protocols include the requirement for multiple recommendation letters penned by independent psychologists as one of the many pre-requisite for GRS, as well as for the patient to have had substantial Real Life Experience living in the opposite gender before GRS can be performed.
However, these protocols and directives, while ostensibly enacted to protect transgendered people from exploitation or from making the wrong choices, are themselves subject to abuse and used as a means for profiteering on the part of medical practitioners. Some consider the Standards of Care a "ritual document" with little clinical usefulness, and only serves the interest of the medical community in preventing lawsuits from those who regret choosing GRS. See http://www.tsroadmap.com/reality/wpath-standards.html for more details.
The reality is that the majority of gender dysphoria sufferers identify their own condition very early in life, often as early as childhood. Unnecessary legislation that prevents them from seeking gender reassignment until a certain arbitrarily defined age, or which places multiple bureaucratic obstacles in their path, only adds to their suffering.
The right of a person to choose his or her own gender should be a fundamental right free from unnecessary infringement from supposedly well-intentioned medical practitioners as well as lobbyists who are evidently still confused over such basic issues like the side effects of orchiectomy.
Thai teens seeking sex changes grapple with new rules | For two years Ponchalearm has yearned for the operation and at 18 he has reached the age at which, under a new Thai health regulation, he can legally make the decision himself. -- PHOTO: AFP |
BANGKOK - MS VALEE Pancharoen watched her son transform as he became a teenager, first painting his nails, then wearing a wig and, finally, the dresses he had been wearing for years but hiding from his parents.
Now 18, Ponchalearm's changes are all the more striking as he sits, slim and ladylike in a top of white satin and black lace, next to his stern and athletic twin brother.
Ponchalearm's aunt absent-mindedly runs her fingers through his waist-length auburn hair extensions as the family quietly discusses whether Ponchalearm is ready for a sex change operation.
'It's my life and I've decided that I must do it before university,' Ponchalearm says. 'I feel happy, it's fun, I can express myself as I want. I'm lucky I have friends who understand me.'
As he speaks, his mother softly cuts in to express her concern that he is too young to understand the long-term consequences of his decision.
'Let's consider this, you're still too young,' she says. 'I want him to take time to grow up a bit.'
For two years Ponchalearm has yearned for the operation and at 18 he has reached the age at which, under a new Thai health regulation, he can legally make the decision himself.
The regulation was introduced in April after health authorities became alarmed by stories and the subsequent public debate about underage boys seeking - and receiving - castrations as the first step toward gender reassignment surgery.
Some gay activists and parents worried about potential side effects of the operation on bodies that are still growing believe the age at which youths can independently make the decision to be castrated should be raised to 20.
'They're trying to do everything to make themselves look like a real woman,' said Ms Nathee Teerarojanapong, head of the Gay Political Group of Thailand.
'Why can't they forget about the external beauty and look inside?'
Thailand is believed to have one of the largest transgender populations in the world. Academics estimate at least 10,000 live in Thailand, though other guesses are more than 10 times higher.
Surgery to remove the testicles apparently carries very little inherent physical risk but the side effects of the hormone drugs that must be taken to hasten the transformation from male to female can include hot flushes, weight gain, muscle loss and a loss of libido, as well as tiredness.
Aside from the psychological impact of that such profound change can bring, some doctors who are expert in gender reassignment insist that any fears of physical side effects are exaggerated.
'There are no serious side effects,' said Dr Thep Vechavisit, a leading Thai sex change doctor. 'People are stupid and talk about things they know nothing about. These activists are hurting transgender people.'
Current precautions, which require men to consider their decision for one year and see a psychologist for assessment of their suitability and mental readiness for the operation, are sufficient for weeding out the half-hearted, he said.
'Usually these kinds of people are very young when they're willing to become a woman,' Dr Thep said.
'They show up and they've made their decision already. In 20 years I have only had one patient come in and say, 'Doctor, I want my penis back'.'
But some people who have already had the operation say the controversy has made them nervous.
Chatpakorn 'Belle' Chotiem, a cabaret dancer in Pattaya, said he was castrated five years ago aged 14, after one of his friends had the operation.
'She was so beautiful, a beautiful girl, and I hoped to be like her so much,' Belle said. 'Now I don't know what to do. I'm so worried about what will happen later.' Ponchalearm's mother said she doesn't want her son in the same situation.
She said she first heard rumours about side effects from a doctor talking about the castration ban on a talk show.
Until then she had been willing to accept her son's decision, Ms Valee said, but now she is not so sure.
'I don't want him to get the operation because I'm afraid he'll get hurt.' If her son won't reconsider, Ms Valee said she was willing to pay for the operation so he could have it at a respectable hospital rather than an underground clinic.
'Whatever he becomes, he's my child,' she said.
Although he says he always wanted to be a girl, Ponchalearm only began thinking seriously about the operation after starting at a new high school where he met about 50 other 'ladyboys' and felt that for the first time in his life he was among people who understood him.
None of his trendy, soft-speaking, cross-dressing friends have yet gone through with sex change surgery, he said, but some are on the one-year waiting list.
He admits the long wait for the surgery - and the thought of the blood that goes with it - have made him squeamish.
'I try to convince myself that I need to do this,' he said. 'I must.' But his mother fears it's a passing phase and see no easy solution.
'My real wish,' she said, 'I wish my son was like normal people. Since he was born male, he should be male.' -- AFP
