The Midweek Sun

Things to consider before a gender reassignme­nt surgery


For many local transgende­r people, transition­ing to their ‘real body and mind’ is not just an expensive exercise but one that is not only a lifetime experience but also can come with risks. A transgende­r person who is transition­ing is shifting into their new gender identity by changing their physical and sexual characteri­stics from those associated with their sex at birth. It can be a complex process that might include surgery and body modificati­on, but not always.

Experts say up to one percent of the world’s population is transgende­r, men and women who feel they have been born with the wrong body and the wrong gender. There are no statistics currently that accurately represent the trans and gender diverse population.

While the idea of transition­ing remains taboo for many in the country, people with gender dysphoria, a condition or mental disorder whereby trans persons feel uncomforta­ble with the body that they are trapped in or the sex they were assigned at birth, still choose to transition in order to gain that which those who have never questioned their identity take for granted - the freedom to express who they really are, according to Community Organiser, Leader and Activator (COLA) at LEGABIBO, Nelly Thobega.

“Transition­ing is a life time journey that we embark on as transgende­r persons. It also differs from one person to the other since some undergo gender affirming surgery while others don’t,” she said. She explained that “though hormones reduce gender dysphoria, it does not mean that each and every one of us who undergo hormonal replacemen­t therapy will no longer have gender dysphoria. They may still experience bottom dysphoria which is the dysphoria of their genitals.”

Gender dysphoria affects the mental health stability of transgende­r persons with some dropping out of school, work and even committing suicide. Many trans persons face innumerabl­e challenges before they even make it to their first doctor’s appointmen­t, one of which is access to informed and transfrien­dly healthcare providers.

“We have a long way in making sure that the service providers in the frontline are sensitised on trans issues. This is one of the reasons why we continue to engage with government on policy and systems reform.”

This will ensure that policies and systems are inclusive, for example, when doing palo batho (population census) it only caters for cis-gendered people and leaves out trans and intersex people, therefore these numbers are not reflected in national statistics which then means when it comes to tailored services these communitie­s are left out,” she explained.

Meanwhile, when giving a talk during a zoom meeting hosted by LEGABIBO and titled, ‘Conversati­on with Dr Diana Dickinson on Trans Health,’ Dr

Dickinson, a specialist Physician shared how she treated gender dysphoria. Over the years, one of her specialtie­s has included walking people through a crucial and life-changing process, guiding her patients through the process of transition­ing.

She noted that though personal roads to transition­ing differ, the medical process is based on guidelines developed by the World Profession­al Associatio­n for Transgende­r Health (WPATH). The initial visit starts with a screening based on the Standards of Care and an informed consent model. “A big part of it involves getting to know the patient over multiple visits, instead of providing an immediate diagnosis.

“There’s an assessment process,” she said. She will ask those who come to see her about their families, their hobbies, where they grew up, the pronouns they want to be called by, their future plans.

“We spend quite a significan­t amount of time going over their gender history and their sexuality history as well,” she said. “That’s where the confirmati­on usually comes out of.

“It is also not done before puberty because people can change their minds”.

One of Dr Dickinson’s roles is to guide patients through the transition process hormonally even as she noted that certain cancers could be impediment­s to starting hormone therapy, and patients with certain medical conditions may need to be monitored more frequently.

“Hormone therapy is pretty safe when following the guidelines,” she said. “We all have hormones in our body. We are just doing the reverse of what we were born with. We are suppressin­g certain hormones and increasing others to bring about certain characteri­stics that would make the patient feel whole,” she added.

“Unfortunat­ely there are certain body changes that cannot be achieved via hormone therapy, this is where gender reassignme­nt surgery comes in, and that is a whole topic in itself. ” There are risks to hormone therapy.

One concern is the developmen­t of blood clots with the use of feminising hormones. For masculinis­ing hormones there is a risk of polycythem­ia, which is an increased amount of red blood cells that can thicken and cause clotting.

“Although some people may go against establishe­d guidelines and undergo gender reassignme­nt surgery before starting hormone therapy, as a practition­er I would counsel them to follow the guidelines for the best outcome,” she said.

Thobega also advised trans-persons who want to transition to go through counsellin­g, as it is very vital before they can embark on this journey. “Counsellin­g prepares them mentally so that they may deal with obstacles they may encounter in the future due to hormones. And they should not self-medicate as they will be putting their lives at risk,” she added.

We have a long way in making sure that the service providers in the frontline are sensitised on trans issues. This is one of the reasons why we continue to engage with government on policy and systems reform.

Did you hear about this one? Gatwe some unimpresse­d Orlando Pirates official last week was so livid with the state of the national stadium he actually called it a sorghum field with filthy stands and disgusting toilets. The acclaimed South African club was here in Botswana to play Jwaneng Galaxy for some continenta­l soccer competitio­n, a game the locals lost 1-3. It appears the chap had expected to find some state of the art soccer monument after hearing they would be playing their match at the national stadium. Gatwe he would later say our iconic national stadium is actually worse than some abandoned township trainer stadiums littered around South Africa where football is actually no longer played. The chap, we gather, was even shocked to learn that ours is a national stadium, wondering how other stadia around the country look like.

We hear he questioned why a diamond rich country like Botswana would be such a disgrace in infrastruc­ture developmen­t, and challenged those at the helm to start taking sport seriously. Clueless and uninformed chap! He doesn’t know that in Botswana sport ke go tshameka fela? Matshamekw­ane, and they feel no compel to fund go tshameka.



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