CC BY-NC-ND 4.0 · Indian J Plast Surg 2022; 55(02): 139-143
DOI: 10.1055/s-0041-1740528
Review Article

Gender Affirmation in India—The Current State of Knowledge, Management, Legal and Legislative Situation

1   Department of Plastic, Aesthetic and Reconstructive Surgery, and Gender Identity Clinic, Fortis Hospital, Delhi, India
› Author Affiliations

Abstract

A mismatch between the birth sex of a person and psychological recognition of self (gender) leads to a gender expression, which is at variance with the societal norms, and thus gives rise to gender incongruence (GI). In the past few years, there has been a significant change in demographics, understanding of etiology, management, laws and legislations in the field of GI. The authors, who have been performing gender affirmative surgeries (GAS) since the past 27 years, present their experience in gender affirmation together with the current state of knowledge. Recent studies report a significant rise in prevalence of GI, which is similar to the experience of author and other large volume Gender identity clinics in India and worldwide. This article endeavors to provide the medical professional with the current state of knowledge in the field of GI, so that they are better equipped to optimally manage these patients.



Publication History

Article published online:
29 June 2022

© 2022. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Stein DJ, Szatmari P, Gaebel W. et al. Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Med 2020; 18 (01) 21
  • 2 ICD 11. 17- Conditions related to sexual health. Accessed October, 22, 2021: https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f411470068
  • 3 De Cuypere G, Van Hemelrijck M, Michel A. et al. Prevalence and demography of transsexualism in Belgium. Eur Psychiatry 2007; 22 (03) 137-141
  • 4 Gupta R, Gupta R, Mehta R, Aggarwal A, Mathur A. Chapter 11-Gender dysphoria. In: Agrawal K, Mahajan RK. eds. Textbook of Plastic, Reconstructive and Aesthetic Surgery Volume IV (259–293). Noida, Uttar Pradesh: Thieme Publishers; 2019
  • 5 Berli JU, Knudson G, Fraser L. et al. What surgeons need to know about gender confirmation surgery when providing care for transgender individuals: A review. JAMA Surg 2017; 152 (04) 394-400
  • 6 Arcelus J, Bouman WP, Van Den Noortgate W, Claes L, Witcomb G, Fernandez-Aranda F. Systematic review and meta-analysis of prevalence studies in transsexualism. Eur Psychiatry 2015; 30 (06) 807-815
  • 7 Conron KJ, Scott G, Stowell GS, Landers SJ. Transgender health in Massachusetts: results from a household probability sample of adults. Am J Public Health 2012; 102 (01) 118-122
  • 8 Winter S, Diamond M, Green J. et al. Transgender people: health at the margins of society. Lancet 2016; 388 (10042): 390-400
  • 9 Gates GJ. How many people are lesbian, gay, bisexual and transgender?. Williams Institute, University of California, Los Angeles School of Law; Los Angeles. CA: Accessed October, 22, 2021: http://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf
  • 10 Zhang Q, Goodman M, Adams N. et al. Epidemiological considerations in transgender health: A systematic review with focus on higher quality data. Int J Transgend Health 2020; 21 (02) 125-137
  • 11 Wiepjes CM, Nota NM, de Blok CJM. et al. The Amsterdam cohort of Gender Dysphoria study (1972–2015): Trends in prevalence, treatment and regrets. J Sex Med 2018; 15 (04) 582-590
  • 12 DSM5 American Psychiatry Association. Accessed October, 22, 2021: https://cdn.website-editor.net/30f11123991548a0af708722d458e476/files/uploaded/DSM%2520V.pdf
  • 13 Zhou JN, Hofman MA, Gooren LJ, Swaab DF. A sex difference in the human brain and its relation to transsexuality. Nature 1995; 378 (6552): 68-70
  • 14 Kruijver FPM, Zhou JN, Pool CW, Hofman MA, Gooren LJ, Swaab DF. Male-to-female transsexuals have female neuron numbers in a limbic nucleus. J Clin Endocrinol Metab 2000; 85 (05) 2034-2041
  • 15 Henningsson S, Westberg L, Nilsson S. et al. Sex steroid-related genes and male-to-female transsexualism. Psychoneuroendocrinology 2005; 30 (07) 657-664
  • 16 Bentz EK, Hefler LA, Kaufmann U, Huber JC, Kolbus A, Tempfer CB. A polymorphism of the CYP17 gene related to sex steroid metabolism is associated with female-to-male but not male-to-female transsexualism. Fertil Steril 2008; 90 (01) 56-59
  • 17 Hare L, Bernard P, Sánchez FJ. et al. Androgen receptor repeat length polymorphism associated with male-to-female transsexualism. Biol Psychiatry 2009; 65 (01) 93-96
  • 18 Fernández R, Esteva I, Gómez-Gil E. et al. The (CA)n polymorphism of ERβ gene is associated with FtM transsexualism. J Sex Med 2014; 11 (03) 720-728
  • 19 Dewing P, Shi T, Horvath S, Vilain E. Sexually dimorphic gene expression in mouse brain precedes gonadal differentiation. Brain Res Mol Brain Res 2003; 118 (1-2): 82-90
  • 20 Gupta R, Murarka A. Treating transsexuals in India: history, prerequisites for surgery and legal issues. Indian J Plast Surg 2009; 42 (02) 233-240
  • 21 Gupta R, Kaushik N, Asokan A. et al. Surgical care: Surgical management of Gender Incongruence. In: Indian Standards of Care for Persons with Gender Incongruence and People with differences in Sexual Development/Orientation version 1. (66–165). Delhi: Wisdom Publishers; 2020
  • 22 Coleman E, Bockting W, Botzer M, Cohen-Kettenis P. et al. Standards of Care for the Health of Transsexual, Transgender, and Gender- Nonconforming People. 7th version. World Professional Association for Transgender Health;. Accessed April 29, 2022 at: https://www.wpath.org/publications/soc 2012
  • 23 Neblett II MF, Hipp HS. Fertility considerations in transgender persons. Endocrinol Metab Clin North Am 2019; 48 (02) 391-402
  • 24 Supreme Court Observer: Challenge to Transgender Persons Act- Swati Bidhan Baruah vs Union of India. Accessed October 22, 2021 at: https://www.scobserver.in/court-case/challenge-to-transgender-act
  • 25 Jain D, Kartik K. Unjust Citizenship: the law that isn't. NUJS Law Review. 2020; 13 (02) 1-44
  • 26 Kozee HB, Tylka TL, Bauerband LA. Measuring transgender individuals comfort with gender identity and appearance: Development and validation of the transgender congruence scale. Psychol Women Q 2012; 36 (02) 179-196