Answered in the Affirmative: Doel’s Transition Story

It’s not a race track with a finishing line. Medical transition is a journey that can have multiple beginnings and ends. 

Ideally speaking. 

But protocols exist. And those in my country require a transgender person to begin their journey of Gender Affirming Medical Interventions (GAMI) with two separate pieces of paper from two different psychiatrists certifying their gender dysphoria* and mental fitness to proceed with the medical procedures of their choice. So, I would say my journey with GAMI started with the baby step of reaching out to a professional psychiatrist recommended by my then-therapist. Here, I must mention a GD certificate can only be issued by a professional psychiatrist and not by a clinical psychologist or a counsellor. Moreover, the number of sessions you may need before the psychiatrist issues the certificate varies from person to person. It took me one or two sessions, as far as I remember. It was 4 years back, and having access to trans-friendly mental health professionals worked in my favour. The process was smooth, and after obtaining the second GD certificate, I was free to reach out to doctors who could help me with my gender affirmation. 

*Gender Dysphoria (GD) is a medical term to describe the feeling of discomfort or distress that occurs in people whose gender identity differs from the assigned gender.

But there were a lot of things on my to-do list and I didn’t have the money to go for all of them at once. So, I decided to begin with Hormone Replacement Therapy (HRT)* under the guidance of an endocrinologist who is well-known among trans women for his expertise on the subject. I have always been lucky to have access to medical professionals who are trans-friendly, not only on paper but in real life, too. The best way to ensure this is going by first-hand experiences shared by trans people in the community rather than the reviews written on the internet. 

*It is important to experience the effects of hormones on one’s body and only then undertake the steps for permanent surgical procedures. HRT is a slow process, with slow up-titration of medications.

After being on HRT for more than 3 years, I started talking to a few surgeons recommended by my fellow trans friends. This was around the same time when I was considering setting up a fundraiser to raise money for the surgery because medical insurance companies in India do not cover gender-affirming medical care. To begin with, I consulted the doctors to learn about the different procedures of vaginoplasty. But the technique I was more inclined towards (sigmoid vaginoplasty) required around 4.5 to 5 lakhs INR – an amount that looked too huge for a person barely surviving in an expensive metropolis. Moreover, just getting bottom surgery was not the only box I wanted to check. So, after a lot of thinking and conversations with some trans folx in the community, I decided to undergo bilateral orchiectomy and breast augmentation from the same plastic surgeon. Orchiectomy, because after being on both estradiol and androgen-blockers, I was 100% sure that I did not want any primary source of testosterone in my body; and breast augmentation because I had always wanted it. The two procedures would cost me around 2 lakhs INR, excluding pre-surgery medical tests and post-surgery care. I decided to get them done one after another at the clinic owned by a reputed and trans-friendly surgeon in Mumbai. I went for an orchiectomy first because it’s one of the least complicated surgeries with a recovery period of 2 to 4 weeks. By then, I had raised the funds I needed for the same (25k INR). 

The experience was very smooth. The staff at his clinic were very sensitised about GAMI, and the anxiety of facing the kind of discrimination at hospitals and clinics we get to read in news reports was gone in a few minutes after I stepped into the clinic. My best friend and my then-partner were a source of constant mental support before and after the procedure. They were soon joined by a few other friends who made my first procedure feel easier and less painful than I imagined.

4 months after recovery, I was back at the same clinic. The money that was left in the fundraiser account wasn’t enough for the second procedure. But it was a huge relief that I had almost half of the amount needed, thanks to the queer community and the contributions from my social circles. The breast implants were already delivered to the clinic, and I did not want to delay the surgery. I took a loan for the remaining amount and went under the knife, quite confident after a successful, smooth, and euphoric orchiectomy. The breast augmentation procedure went well, and it took me about 6 weeks to completely recover. In the beginning, I felt some heaviness in my chest, but it slowly improved. This is a surgery that requires a few weeks of aftercare, and the post-operative compression bra is a must-have during this period.

Changes in the body can be overwhelming. While the changes under HRT are gradual, the ones after a 30 or 60-minute procedure can feel too fast to process. Pain and soreness can still feel manageable but the psychological effects can get intense. This is where the presence of a strong support system of friends and community and access to trusted therapists play a vital role. But I must mention that being under androgen blockers for a considerable period had prepared me for the potential effects of orchiectomy on mental health. I could feel the immense gender euphoria outdoing the pain and discomfort every passing day. It’s a sense of euphoria that answers a question asked long ago by a trans teen, “Isn’t being and becoming the same thing?” And it was answered in the affirmative. 

Medically reviewed by:

Dr Asim Maldar, Endocrinologist