THEY feel that they are women trapped in a man's body. So they seek the scalpel to change their sex. But do they know what they're doing? At least two thought so.
One killed herself when her relationship with a man broke down. Another plunged into depression because she could not cope with life as a woman. A session with psychiatrists before they changed their sex could have solved the confusion.
But no, the two are among a growing number of transsexuals who are avoiding psychiatric counselling by heading to Bangkok to have their operations done.
Singapore psychiatrist Tsoi Wing Foo has counselled 1,000 transsexuals since 1973 to see if they are ready for sex-change operations. In the past 10 years, however, the 70-year-old grandfatherly man with thick, black-rimmed glasses hasn't counselled any male transsexuals (those who are born male and want to be women). And he sees an average of only one female transsexual a month. He's not alone in his concern.
Psychiatrist Lionel Lim has seen only four transsexuals in the last four years, compared to one to two a month previously. And Dr Simon Siew, also a psychiatrist, has not seen any in the past year.
Why? There are a few reasons. One is that many male transsexuals go to Bangkok for the operation, where it's often pay up, few questions asked, snip, and take the flight home. It's cheaper by half and faster. Transsexuals say a male-to-female operation in Bangkok would cost between $3,000 and $6,000, while the same operation here would cost double that figure.
Ms Amy Tashiana, a 37-year-old transsexual, was undergoing a few sessions with a Singapore psychiatrist 15 years ago when told that a Bangkok operation would cost half as much, without the need for psychiatric assessment. The show promoter and entertainer packed her bags at once. She said: 'In Bangkok, you just make an appointment with a doctor, give the money and that's all they need to operate on you. 'That's what happened to me. I just told the doctor what I wanted, snip snip and voila, I woke up a woman.'
But it isn't just a question of money. The worry is that for some haste can lead to regret, depression and in extreme cases, suicide. Dr Tsoi said: 'Many of them would not have gone through a psychiatric assessment before the operation. 'Many think that the operation is a miracle that can change them from a male to a female and vice versa. 'But the operation doesn't transform them into the opposite sex; it only allows them to be registered as their chosen gender. 'If they've not (adjusted) to their lives as the opposite sex before the operation, they're not suitable for the operation. 'Counselling is to make them realise they are the ones who make themselves men or women, not the op.'
Certainly, Ms Amy is worried about the consequences when fellow transsexuals are not properly counselled before opting for the operation.
'Some of them are not transsexuals,' she said. 'They may be transvestites or gays who opt for the operation to get boyfriends, or they may do it for money (by prostituting themselves). 'They see how easy it is for us (male) transsexuals to get men and so go for the operation which they later regret.' Ms Amy has seen one friend take her life after her boyfriend left her, and another slip into deep because she couldn't adjust to life as a woman. Neither had received counselling before the operation.
Psychiatrists in Singapore require transsexuals to live and dress as a member of the opposite sex for at least a year before allowing a patient to go through with the operation. Half of those Dr Tsoi sees are not deemed suitable for the operation. He added that the counselling sessions also help to make transsexuals aware of the difficulties they might face after they've gone through with the operation.
One transsexual, freelance writer Leona Lo, 28, was told to be prepared to face discrimination. She said: 'I was very much prompted to get a Masters degree after talking to my doctor. 'The doctor told me that I was in for a difficult time and I had to be twice as good as other people if I wanted to be accepted.'
Ms Lo graduated with a Masters in Sociology from the University of York in 2001, four years after going through her sex-change op. Transsexuals interviewed said that there was a real shortage of information here. They get information on the surgery from their friends or the Internet - not from any official channels.
The National University Hospital's Gender Identity Clinic (GIC) is the only facility for sex-change operations here. Since 1971, when the late Professor S S Ratnam performed Singapore's first sex-change operation, there have been 500 such procedures. That's an average of 17 a year. But the GIC has done no male-to-female operations since 2001. Since September 2001, it has done only four female-to-male operations.
The New Paper on Sunday could not find any information on the GIC on NUH's website, and we were unable to speak to the current consultant, Dr Ilan Cheran.
When asked about the GIC's services, an NUH spokesman replied: 'The NUH Gender Identity Clinic reopened in September 2001 to provide a service to those who request it."
'Thus far, the clinic has served its purpose well.' Dr C Anandakumar, who was the specialist-in-charge at the GIC until 2001, recounted how, during his time, consultations with transsexuals could only be done on Saturdays and after office hours, as NUH had very little interest in encouraging sex-change operations. Transsexuals would also need to book themselves into single wards after the operation as Dr Anandakumar claimed 'the hospital did not want the transsexuals to mix with other patients'. This would push up the cost of the operation, prompting many transsexuals to head to Bangkok for more affordable treatment. This may have changed.
An NUH spokesperson said, in reply to queries from The New Paper on Sunday: 'All our patients are important to us and we care for them with respect and sensitivity due to any individual. 'The Gender Identity Clinic operates at the usual hours, as per all other hospital clinics. Patients stay in single room as per MOH regulation since the seventies.'
Ms Lo, 28, had her psychiatric assessment here but the operation was done in Bangkok. She felt the lack of inforation about the services provided by the GIC deterred transsexuals like herself from having the operation done here.
'Many of us can't be bothered to find out more about the GIC as it's so secretive about its services. 'It signals the clinic is not interested in helping and is ashamed of us. There's always the Bangkok and the surgeons there have done so many operations. The more operations they perform, the better they get. So we're happy to go there.' But not all transsexuals are flocking to Thailand. Female transsexuals are still seeking help from the GIC.
Such operations are more complex and cost $15,000 or more here. But Dr Tsoi believes many female transsexuals will head to Bangkok as well once the operation is available there.
Some regrets, but she goes on with life
SHE confided in a friend that she may have regretted going for a sex-change operation. But she told The New Paper on Sunday that there was no point wallowing in regret. 'I have to go on with my life,' said Nur Sarafina Mustafa. The 29-year-old freelance make-up artist went to Bangkok for an operation that transformed her physically into a woman. She did not feel she needed a psychiatric assessment before the operation. Neither did the surgeon who performed her operation require one of her. But Ms Sarafina has found that life can be quite daunting after the operation.
Her relationships with men have not been smooth sailing so far. She broke up with her first boyfriend as she could not bear to see him fight with his parents over her. His parents never approved the relationship even though the pair had known each other since secondary school. He also paid for her sex-change operation in 1995. She broke up with her second boyfriend last year as he wanted a woman who could bear children. Such bitter experiences have left her questioning the operation she had, especially when her own parents cannot accept her as she is now.
'My parents disowned me after I told them I went for the operation. They thought I had disgraced them,' she said. She's tried calling her parents since then but their reply is always a terse 'We don't have a child like you' before the line goes dead. Asked whether going for counselling sessions would have prepared her for the difficulties she has encountered after the operation, Ms Sarafina replied: 'I didn't think of that.'
TRANSSEXUALS are often mistakenly grouped with transvestites. But the terms are not synonymous. A transsexual is someone who has a persistent desire to surgically and legally change his/her gender. A transsexual feels a strong need to alter the body to match the inner self. Transvestites do not dislike their genitals or want to get rid of or change them. Transvestites are always male while transsexuals can be of either sex. Transsexuals cross-dress to conform with the inner self. Transvestites cross-dress (as women) to get sexual satisfaction.
The biggest misconception that people have about transsexuals is that they choose to be the way they are. Psychiatrist Tsoi Wing Foo said: 'People need to understand that transsexualism is an inborn condition and not a sexual perversion.' He admitted he did not think transsexuals should be operated on when he entered the field in 1973, but changed his mind as he learnt more about them.
Dr Tsoi said: 'My negative feeling about transsexuals was due to ignorance and lack of exposure to them. 'But as I went deeper into the field, I found that they cannot live the lives of the sex they have been born into. 'As one patient told me, 'Who wants to pay money to have their sex organs taken off?', it's not something that they can help.'