Thailand was always considered the ?go-to? overseas destination for gender-change surgery, but not anymore. India is going through an "exponential rise" in patients.
Since the mid-1970s, foreigners have flown into Thailand as men and later flown back out as women. The Philippines, too, was something of a hotspot. Southeast Asia in general was long thought to be more tolerant of transgenderism.
But now gender affirmation surgery is easing into the mainstream, it's big business, and the industry is booming in a new destination: India.
So much so that surgeon Dr. Narendra Kaushik has erected a purpose-built hospital solely for trans patients. His Olmec centre in Delhi handles up to 70 patients a month, with many undergoing multiple procedures. Olmec performs around a thousand surgeries every year; 600 of these are to change the genitalia from male to female or female to male.
"We have undergone an exponential increase in the past seven years or so," Dr. Kaushik told RT.com. "It's mostly male-to-female surgery as this is what is reflected in society, but we are also getting female-to-male patients."
For every patient born female who wants to make the change to male, there are three patients who want to make the leap from male to female. What does the surgery entail?
GRAPHIC CONTENT WARNING
"We take away the testes," explained Dr. Kaushik. "We then use the outer parts of the penis to make the female genitalia in a beautiful way, including a clitoris with good sensations from the glans of the penis, and this makes orgasm possible.
"In the past, the majority of sex-change operations meant patients had to live without sexual intercourse. Not anymore. We have a 98.3% satisfaction rate amongst patients and their partners.
"We cannot say they are absolutely normal female genitals because they are made from the male organs but they are as close as is possible in terms of function and appearance. She feels like a woman."
As with any surgery, the experience is not exactly pleasant.
"Believe me when I say it's very, very painful," Isabella Thalund told RT.com. "But absolutely worth it - when you are in my situation, obviously."
Isabella, 33, travelled to India from her home country of Denmark in the autumn for genital surgery and paid around $14,000 including flights. That's already expensive to most people, but Dr. Kaushik estimates that full gender alignment surgery can cost between $30,000 and $40,000. That could include reduction of the Adam's apple, breast surgery and - often the most expensive element - facial feminisation surgery. It depends on the individual.
But those costs are tiny compared to the US, where bills can reach way over $100,000 for similar treatments. And in Denmark, says Isabella, there is also a six-year waiting list for less effective surgery in the public sector. It's a two-year wait in the UK just to get an appointment to see a specialist, as demand has reached record levels. Some 5,700 people are waiting for an appointment at London's main gender clinic, the Tavistock and Portman Foundation Trust, alone.
Treatment in India includes everything from pick-up at the airport to the drop-off back at the terminal five or six weeks later with an entirely different body. It also usually, in times when Covid is not on the rampage, includes a tourist trip to destinations such as the Taj Mahal.
"As I was already out when I underwent the surgery; it hasn't made a big difference in how I interact with people around me, but for me personally, it just allows me to feel 'correct'," Isabella told RT.com.
"Having male genitals was a constant reminder that I was born 'wrong' and I also would constantly limit myself in what I could do and what I would wear, as I feared anyone else seeing.
"After surgery, I no longer worry about clothes being too tight and I am excited to be able to use the changing room like any other woman.
"As to why I chose to go to India, it was partly because of the price but definitely also because of the surgeon."
Patients are only accepted after a minimum of a full year of female hormone treatment and a thorough psychological evaluation for gender dysphoria, essentially meaning they feel the opposite sex to that into which they were born.
But the recovery from surgery doesn't take all that long and it doesn't hurt as much as it used to. Patients are usually up and walking in four to seven days. And the results of the modern technique, pioneered by Dr. Kaushik, called Sigma-lead, can be remarkable.
In his two decades in the field, Dr. Kaushik has operated on around 10,000 transgender patients and carried out over 16,000 operations. The youngest was aged 19, the oldest in their late 60s. Some come for corrective surgery on less effective procedures carried out elsewhere, and not all get the full change.
Around 20% of Dr. Kaushik's patients are from outside India, and he's recently operated on people from the US, Europe, and Australia. At least a thousand foreigners have been through his doors. He operates on two or three patients most days.
Accurate figures for how many people have travelled to Asia for gender surgery don't exist but, if Dr. Kaushik's busy clinic is anything to go by - and there are many such clinics across India, Thailand and the Philippines - it must be in the thousands. There are at least 100 doctors qualified to carry out gender surgery in Thailand alone.
The Olmec trans-specific clinic in Delhi was only inaugurated in 2019 to help deal with the demand, and Dr. Kaushik operated on a dozen foreign patients in December 2021.
"We are looking forward to further expansion," said Dr. Kaushik.
Indeed. The demand is only going to increase, especially as the cultural stigma decreases.
"If someone is male externally but female internally, psychologically, it is a constant demand from the mind to have the female gender," he told RT.com. "Only surgery will satisfy this and make them happy. This is a fact, this is the reality."
And for people who undergo the treatment, it's a matter of turning their bodies into how they've felt most of their lives.
"It is very hard to imagine how it feels without being transgender, but if you imagine someone deliberately calling you a different name than your own every single day, it sort of comes close," Isabella told RT.com.
"I am not hurting anyone by being who I am, I am simply looking for acceptance to be allowed to be who I am. And to be allowed to be happy.
"I finally feel complete. After a journey of more than 10 years, I can finally be at rest with myself. I am happier, much less stressed and very, very hopeful for the future."