Mak Nyahs and Sex Reassignment Surgery – A Qualitative Study from Pahang, Malaysia

Introduction: Mak nyahs are locally known male-to-female transgenders in Malaysia. In Western countries, medicalization of transgenderism allows strictly selected patients to undergo sex reassignment surgery. However, a standardized treatment system is not yet available in Malaysia. A number of mak nyahs underwent sex reassignment surgery at their own will. This study aimed to explore mak nyahs’ knowledge and perception on sex reassignment surgery. Materials and Methods: A qualitative research was carried out from 13th July 2016 till 31st August 2016 among 8 adult mak nyahs in Kuantan, Pahang. Snowball sampling was used. Participants who gave verbal consent were interviewed individually and in focus groups. Data obtained was transcribed and used as the primary data source. Results: All informants were Malays and Muslims. They generally had some knowledge about the standard procedures and risks in sex reassignment surgery. All informants expressed their desire to have the surgery, but chose not to. Reasons discouraging them from having the surgery were: i) religion, ii) forbiddance from family, iii) fear of regret, iv) death from surgery, and v) the lack of necessity. Factors driving them to have the surgery: i) more income from sex work, ii) pressure from sex clients, iii) securing a stable relationship, iv) self-satisfaction, and v) hope for a better future. Conclusion: Religion seemed to be the main reason refraining them from undertaking the surgery. Counselling mak nyahs should include the advantages and disadvantages of sexual reassignment surgery. Islamic religious preaching is very important to help reduce high risk behaviours, as well as teaching mak nyahs to cope with challenges in adult life. Further research is necessary to show association between religious knowledge and successful rehabilitation of the mak nyahs’ community.

Begging for change: Hijras, law and nationalism

This article begins by examining multiple drafts of a parliamentary legislation that aims to provide rights and reservations to transgender persons in India, so as to trace the ways in which hijras have been absorbed into the discourse of nationalism. The most current draft of this bill, ‘The Transgender Persons (Protection of Rights) Bill of 2016’ shows that despite claims to protect transgender citizens, the state uses the discourse of nationalism to justify the increased governmentalisation of hijra bodies and lives. I bring attention to the state’s insistence on the distance between homosexuals and hijras and the active endorsement of Sexual Reassignment Surgery to argue that the legislations are consolidating heterosexuality rather than making space for queer citizens. The project of heterosexualisation marks the disjuncture between colonial and contemporary ambitions of policing hijras, which have remained remarkably consistent and centred around their economic activity of begging. Based on ethnographic research conducted in rural Odisha, I question the glossing of hijras’ practice of seeking alms or challa as begging, to show how limits of nationalism are drawn and render hijra forms of being as incommensurable with the state.

Gender Dysphoria

In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), gender dysphoria (GD), previously known as gender identity disorder, is defined as distress or impairment in psychosocial, occupational, educational, or other areas of life due to a perceived disagreement between a person’s assigned gender, natal gender, and the gender currently experienced or expressed for at least 6 months. The DSM-5 mentions that one’s experienced gender may be outside of binary gender stereotypes. Diagnostic criteria are different for GD in children and in adolescents/adults. This review covers the definition, epidemiology, etiology/genetics, clinical manifestations, and studies/tests/treatments related to GD. Tables list the diagnostic criteria for GD and definitions of common terms. This review contains 2 tables and 30 references Key words: DSM-5, gender dysphoria, sexual reassignment surgery