State of change

AUSTmagLOGOShe sits in a bamboo chair in the steaming Bangkok heat, slim and elegant in a long skirt and a black sleeveless vest. Her eyebrows are delicately plucked, her ears pierced, her hair long and wavy. She turns and smiles sweetly. She has been a woman for less than a fortnight.

Tara was never happy with her masculinity. After years of taking hormones, she finally decided to take the plunge and change gender. Earlier this year she had a series of operations to remove her male genitalia, construct a woman’s genitals, augment her breasts and reduce her Adam’s apple.

She flew to Thailand from Australia’s east coast for the surgery, her mother in tow for moral support. At the age of 33 she became a woman, and left the detritus of her manhood behind her in Bangkok. A short time after surgery the only outward indication that she was ever male is a faint pink line on her neck where her Adam’s apple once protruded. Now she wishes she had done it when she was much younger. “I’ve never doubted it,” she says, with a wide smile. “It’s always been the right thing that I needed to do.”

Tara, shortly after her final surgery. Photo Sian Powell

Tara, shortly after her last operation. Photo by Sian Powell

Gender, it seems, is becoming increasingly malleable. Recently a NSW resident was reportedly accorded the right to avoid the M/F distinction. Born a male, he/she became a female via surgery and drugs, got fed up with the time-consuming physical and pharmaceutical maintenance, and reverted to someone in the middle of the gender arc. Increasing numbers of people around the world turning to surgery to manipulate gender; others spurn the surgery and simply use drugs to restrict hair growth and encourage breasts, or visa versa. A talented South African runner was apparently recently found to be “intersex”, with the internal sexual characteristics of both genders.

The authorities are becoming accustomed to the gender changeover. Cuba has instituted state-sponsored sex change operations, and the US Tax Court has handed down a decision agreeing that sex change operations and procedures should be tax deductible. In Australia the Family Court has permitted a number of youngsters to embark on hormone treatment to ward off the sexual characteristics that begin to burgeon with puberty. Decades after James Morris, a well-known historian and journalist and a father of five, took his first tentative steps toward femininity, world opinion is becoming more comfortable with the notion of changing gender.

Tara’s friends talked her out of it when she first planned a sex-change operation many years ago. “It was ruining my life, I was living a whole secret life,” she says, with a faint smile. “Around the age of 20, I was pretty intent on doing it then, but people talked me out of it. So I waited. I should never have waited.”

She knew, though, that she was female, despite tangible evidence to the contrary. The realisation dawned as her masculine hormones kicked. “For me it was just after puberty,” she says, sitting in the garden of her Bangkok hotel, convalescing from the first round of surgery, just before her Adam’s apple was to go under the knife. “I felt like there was something wrong with that. When I was 16 or 17 I started wearing girls’ clothes. I was quite intent on transitioning then; you can do it before you’re 18 if you have parental consent. It’s important to do it before you’re 30, when you start getting thicker body hair, the hair on your head starts receding …” she pauses, and laughs.

These days it’s hard to believe Tara was once a young man. Her voice is low and musical. Her newly augmented breasts are sore, but the pain doesn’t stop her going shopping in Bangkok’s glitzy malls. She smiles gently, and pulls at a stray strand of her hair. Although she didn’t technically change gender until she was 33, she looks entirely female. Some of the other women in the hotel courtyard near the sex change clinic have not had quite the same luck – perhaps they left it too late, or perhaps their male hormones were harder to overcome.

Tara has been taking hormones since 2006, and trying to take the final steps toward womanhood. “But I wasn’t able to do it in the city where I was living; knowing people, the work that I was doing,” she says ruefully. “I didn’t tell my family for a long time, probably ‘til I was nearly 30. My brother had known since my teens, but I didn’t know he knew. I suspected my father would kick me out of home. When I changed my name he wouldn’t talk to me for a year. Now he makes a big effort.”

She has accepted that she will have to take hormones for the rest of her life, and ensure that her new vagina is regularly stretched, for at least an hour a day to begin with, to prevent it collapsing in on itself – something that usually requires surgical correction.

She is remarkably straightforward about her body and her sexuality. She wants to make it clear that when she was technically a man, she never thought she was homosexual, and after she started taking hormones her libido nose-dived anyway. “I never really worried about that,” she says, referring to the complexities of her sex life. “I used to have sex mostly with women. I didn’t like sex with men; I didn’t have the right bits. I was never really that sexual anyway. I didn’t have the right parts to do it comfortably”.

Tara, relaxing. Photo by Sian Powell.

Tara, relaxing. Photo by Sian Powell.

Tara is not her real name; nor does she want to be too specific about what she is studying at university, even though she is willing to have her photo published. Anonymity is a blessing, she says. Certain limited individuals can be very cruel, but perhaps, at long last, the tide is beginning to turn.

Last year, the Australian Passport Office issued 202 passports in which the stated gender was different to an earlier passport, or to a birth certificate. Tara’s surgeon, Dr Kamol Pansritum, says he presided over ten sex change operations on Australians over the past year; a number that has been steadily increasing, and he knows of at least ten other surgeons in Bangkok who provide a similar service.

Patients come to Bangkok from all over the world to have their gender changed. Dr Kamol alone presided over more than 100 sex change surgeries last year. Katherine Cummings, from the government-funded Gender Centre in NSW, says that she hears of more and more people wanting to travel to Thailand for surgery rather than having the operation in Australia.

“Descriptions which came back from the early changelings, painting excellent pictures of the skill, medical professionalism and courtesy of the Thai professionals, the lower cost, the chance to have a short vacation in Thailand as part of the process, all persuaded an increasing number of transgenders to choose Thailand as their option,” she says. Cummings, who was born male, edits the Centre’s “Polare” magazine. “I think, too, the Internet had its part to play, as it does in so much of our lives these days. The Thai surgeons tend to have excellent, informative and attractive web pages and communication is much easier than it once was, with the immediacy of a phone call combined with the option of a printed output which can be used for permanent record-keeping or for comparison shopping.”

Still, ever diligent, the Australian government sounds a note of warning. “Medical tourism, including for cosmetic and sex-change operations, is common,” its SmartTraveller website advises. “Australians should ensure that they are not lured to discount or uncertified medical establishments where standards can be lacking resulting in serious and possibly life-threatening complications.” PAR AMENDED AND MOVED UP One enterprise, the Pratunam Polyclinic, has frequently advertised on the front page of the English-language Bangkok Post newspaper: US$1,625.00 for a sex change (the $125 cost for “orchiectomy” – testicle removal – is crossed out, for reasons which remain unclear).

Tara’s doctor, Dr Kamol, has a case-load that is about 60 per cent foreigner, 40 per cent Thai, and the foreign proportion is steadily increasing, perhaps propelled – as Cummings suggests – by the Internet.  “People can search for information easily, including an increasing number of Australians,” the surgeon says. “People come here because the cost of living and the cost of surgery is low. Compared with the US, it’s about one-third.”

Male to female transformations make up 90 per cent of the gender reassignments, female to male the remaining ten percent, Dr Kamol says, except starngely enough, for Japanese patients. Proportionately more Japanese women want to become men, a difficult and multi-stage series of surgeries. Constructing a penis is difficult, contouring a female body to look masculine is difficult. Sometimes the patient has to undergo as many as ten procedures. Travelling in the other direction can be difficult as well – in addition to Adam’s apple reductions, men often want forehead shaves or jawline changes. Most want larger breasts and some want hip enhancements. Many want a higher voice. Then there is hair removal: a painful and lengthy procedure for certain nationalities known for strong beard and bodily hair growth.

A few men transitioning to women don’t need breast augmentation; the female hormones stimulate the growth of small breasts – but Dr Kamol says most want larger ones for enhanced femininity. Most vaginas are constructed from scrotal or penile skin, but sometimes tissue from the colon is used – particularly if the female hormones have reduced the size of the male genitalia so much that it is unusable for vagina construction.

Dr Kamol has been a sex-change surgeon for 12 years, and he makes it clear that even the easier male-to-female operations are long and difficult – entailing many hours on the operating table, as many as eight at a stretch, depending on the scope of the surgery. He says he has many grateful clients, and an elevator door at his clinic is emblazoned with the face of a beaming woman who has been crowned Miss Tiffany, the premier award at Thailand’s biggest transgender beauty contest.

While she doesn’t expect to win a beauty contest, Tara has been messing around with make-up with her new friend, Claudia Davie, a 24-year-old from Sydney’s beachside suburbs. Claudia isn’t her real name, and she doesn’t want her photo published, but she transformed into a woman so successfully that she has done some photographic modelling work. But the transformation wasn’t completely successful, because Claudia, caught up with love problems, forgot to keep dilating her vagina and it closed over. She is back in Bangkok for surgical correction, and another vagina – this time made from skin from her colon. Despite the difficulties, and the heartbreak of realising she needed a second round of surgery, she has always been very happy with her new female identity.

“When I was in high school I thought I was wrong,” says the tall young woman with striking features and long black hair. “I used to pray to God every night to let me wake up and be a girl.” She was amazed when she found surgery could transform her into a woman, at a cost of many thousands of dollars. She rang her mother, crying. “I am a woman trapped in a man’s body, but I don’t want to lose you, I don’t want to lose the family.”

With her mother’s support, she began taking estrogen pills and testosterone deleters when she was 18. The hormones made her breasts develop and her male genitals shrink, and they helped inhibit body hair. But she still had to have 15 painful laser treatments over two years to eliminate the hair on her chin and upper lip, which she says was “like a hot rubber band flicking against your face”.

She first had her breasts enhanced in Thailand for $3,500, and then, four months later, when she was 21, she underwent her first sex reassignment surgery, an operation which took eight hours on the table and cost her mother a grand total of $18,000.  The surgery went well, but the follow-up maintenance requirements were gruelling. Claudia had to dilate her new vagina with a dildo-like object, for an hour twice a day for the first three months, and a little less frequently after that. “It wasn’t easy, I hadn’t prepared myself for it,” she says. “It was a fresh wound, I had to probe it with a glass stick. I was working full-time, I had problems, I lost focus on dilating, and I missed for a week. Then it literally felt like a brick wall.” Dr Kamol says this ‘healing’ happens in five to ten percent of cases. In the early days of her recuperation from her second operation, Claudia has to be very careful to ensure the raw flesh of her new vagina doesn’t begin to knit together. “If I missed a dilating session for a day now, I would lose an inch.”

She thinks she is lucky in other ways. She hasn’t needed facial surgery: she didn’t need her Adam’s apple reduced, nor cheek implants, nor a forehead scrape or her hairline altered. Her body hasn’t been surgically contoured, a trend amongst Asian men becoming women. Claudia says they often want a curvy, hourglass figure, and they have silicon injected into their hips, often illegally and, incidentally, dangerously.

Still, she is forthcoming about the emotional, as well as the physical, difficulties faced by men transforming into women. “Transgender girls really let guys shit on them. They think they’re less of a person. ‘I’ll just take his bullshit; I’m not going to get any better’,” is often mantra, she says. “They crave male attention way too much. I went through a stage for a while when I just let guys use me. I had no substance. I transformed into a tart, not a woman. I thought ‘things have got to change, it’s back to the real me.’ Once I fell for a guy, and finally told him (about her real gender). He slapped me. He said ‘you’re a disgrace, people like you should be murdered, how could you deceive me?’ He made me feel like a piece of scum on the road.”

Claudia tosses her long back hair and grimaces, putting a brave front on her humiliation. “I said, ‘I have breasts and a penis: deal with it’.” In Bangkok with her sister, who is having her breasts augmented, she says that despite all the trauma of transformation she could see no other way of living. “I wanted to have sex like a woman, I wanted to speak like a woman. I wanted to touch like a woman. But it has cost so much money, so much pain.”

Being a man gave Tara anxiety attacks. For her, taking female hormones was like taking anti-depressants. Before her sex reassignment surgery she was living a secret life, at least at times; worried about increasing hair on her body, trying to cope with the ambiguities of her gender and her sexuality.

Neither Claudia nor Tara have been celebrating their new – and renewed – womanhood. It has been such a long time coming, and there have been so many steps along the way, and so much anguish and surgery, and so many pharmaceuticals, it has just become yet another stage in the long journey to feeling real, and whole, and at one with their inner selves.