gender reassignment surgery singapore

First sex reassignment surgery

Singapore infopedia.

by Chan, Meng Choo

The first sex reassignment surgery in Singapore was successfully performed on 30 July 1971 at the Kandang Kerbau Hospital (now known as the  KK Women’s and Children’s Hospital ). The operation involved a 24-year-old man and was the first procedure of its kind carried out in Singapore. There had been similar operations done in Singapore, but these mostly involved patients who had both male and female genitalia (hermaphrodites) and the removal of one set of genitalia. 1  The 1971 operation was regarded as the first because it involved a surgical conversion aimed at functionally changing a person’s sex and appearance. 2 Patient and diagnosis The patient was a 24-year-old Chinese Singaporean. Her name was kept secret, but her background was later made public in a book. Born the eldest son in a family of five with two younger sisters, her father was a dentist who was often physically violent with his wife, which caused the patient psychological trauma. As a child, the patient was raised by her grandmother, who dressed her as a female. In her teenage years, she associated with other cross-dressers before frequenting the transgender scene on  Bugis Street  as an adult. 3 From the age of 16, she worked as a sales assistant, a housemaid, in a bank and as a public relations officer in a hotel. She later won second prize in a beauty contest and became a model. While working as a part-time model, she joined a cabaret in 1968 and was known as “Mama Chan”. She also ran a social escort service. 4 Having lived as a woman for some time, in 1969 she first consulted Professor  S. S. Ratnam , a senior lecturer in the  University of Singapore ’s Department of Obstetrics and Gynaecology. She had been suffering from sexual and emotional problems, which led to two suicide attempts. Ratnam explained to her that he had no experience in sex reassignment surgery, but she continued to visit his clinic weekly. After researching the subject of transsexualism and sex reassignment surgeries, Ratnam familiarised himself with the surgical techniques by practising on cadavers. 5 The patient then underwent a psychological analysis by a team of psychiatrists who confirmed that the patient was a transgender who required surgery. 6  The diagnosis required the patient to possess a continual sense of inappropriateness about his or her anatomic sex, a desire to discard his or her genitalia and live as a member of the opposite sex, and the absence of physical intersex symptoms or genetic abnormalities. In addition, the gender confusion (gender dysphoria) must not be caused by other disorders such as schizophrenia. 7  The patient was also cautioned that the surgery would be irreversible, potentially involved a number of complications and required a prolonged follow-up period. 8  A total of six to nine months of medical and psychiatric tests had to be carried out before the patient could take the operation. 9 Legal clearance for the operation was then sought from the Ministry of Health and granted. After consideration of the patient’s psychological profile and the medical expertise involved, with the approval of the ministry, it was decided to proceed with the operation. 10  Operation and impact The operation was performed by Ratnam and two other surgeons from the University of Singapore’s Department of Obstetrics and Gynaecology, Associate Professor Khew Khoon Shin and plastic surgeon R. Sundarason. 11  Photography of the operation was not permitted. Ratnam later described the three-hour operation as a success, with an uneventful post-surgery recovery. 12    After her successful operation, the patient went on hormone treatments 13  and was functionally a woman, though she could not conceive or menstruate. 14  She later married a French man and owned a travel agency in Paris, before moving to England. 15 The July 1971 operation paved the way for sex reassignment surgeries in Singapore and the region. Singapore’s first sex reassignment operation on a woman took place three years later. It was carried out in three stages between August 1974 and October 1977. 16  Female-to-male conversions are more complex and involve several surgical stages. 17  In the 1970s and ’80s, hospitals in Singapore accepted numerous sex change patients from abroad, with foreigners making up around half of all surgeries performed, while the rest were locals and Malaysians. 18   In the years following the operation, a number of legal issues arose for transsexuals – those who had undergone a sex change. The Registry of Marriages implicitly recognised marriages involving a transsexual, as it required only an identity card to prove the different genders of the couple. 19  In 1991, however, a marriage between a transsexual man and a woman was declared void by the  High Court , officially making such marriages illegal in Singapore. 20  It was only in 1996 that the government amended the Women’s Charter to allow transsexuals to marry legally. 21 Author Chan Meng Choo References 1. Yeo, J. (1971, July 31).  First sex change surgery in S’pore .  The Straits Times , p. 17; Tan, W. L. (1971, August 25).  Sex change patient has marriage plans .  The Straits Times , p. 8. Retrieved from NewspaperSG. 2. Tan, W. L. (1971, November 11).  They’re still ‘misters’ despite sex change .  The Straits Times , p. 8. Retrieved from NewspaperSG. 3. Ratnam, S. S., Goh, V. H. H., & Tsoi, W. F. (1991).  Cries from within: Transsexualism, gender confusion & sex change . Singapore: Longman Singapore, pp. 25–26. (Call no.: RSING 616.8583 RAT) 4. Ratnam, S. S., Goh, V. H. H., & Tsoi, W. F. (1991).  Cries from within: Transsexualism, gender confusion & sex change . Singapore: Longman Singapore, pp. 25–26. (Call no.: RSING 616.8583 RAT) 5. Ratnam, S. S., Goh, V. H. H., & Tsoi, W. F. (1991).  Cries from within: Transsexualism, gender confusion & sex change . Singapore: Longman Singapore, pp. 25–26. (Call no.: RSING 616.8583 RAT) 6. Yeo, J. (1971, July 31).  First sex change surgery in S’pore .  The Straits Times , p. 17; Tan, W. L. (1971, August 25).  Sex change patient has marriage plans .  The Straits Times , p. 8. Retrieved from NewspaperSG. 7. Ratnam, S. S., Goh, V. H. H., & Tsoi, W. F. (1991).  Cries from within: Transsexualism, gender confusion & sex change . Singapore: Longman Singapore, p. 4. (Call no.: RSING 616.8583 RAT) 8. Chua, M. (1974, November 7).  Who really needs a sex-change?   The Straits Times , p. 10. Retrieved from NewspaperSG. 9. Lim, S. (1990, May 20).  Legal poser over sex-change transsexuals who get hitched .  The Straits Times , p. 21. Retrieved from NewspaperSG. 10. Tan, W. L. (1971, November 11).  They’re still ‘misters’ despite sex change .  The Straits Times , p. 8. Retrieved from NewspaperSG. 11. Tan, W. L. (1971, August 25).  Sex change patient has marriage plans .  The Straits Times , p. 8. Retrieved from NewspaperSG. 12. Yeo, J. (1971, July 31).  First sex change surgery in S’pore .  The Straits Times , p. 17. Retrieved from NewspaperSG. 13.  Second sex change operation in S’pore . (1971, November 5).  The Straits Times , p. 15. Retrieved from NewspaperSG. 14.  Why sex-change patients set up homes overseas . (1975, August 10).  The Straits Times , p. 5. Retrieved from NewspaperSG. 15. Ratnam, S. S., Goh, V. H. H., & Tsoi, W. F. (1991).  Cries from within: Transsexualism, gender confusion & sex change . Singapore: Longman Singapore, p. 26. (Call no.: RSING 616.8583 RAT);  She tried to commit suicide.  (1992, January 18).  The New Paper , p. 20. Retrieved from NewspaperSG. 16. Kwee, M. (1974, October 20).  S’pore’s first sex change woman .  The Straits Times , p. 1. Retrieved from NewspaperSG. 17.  Why sex-change patients set up homes overseas . (1975, August 10).  The Straits Times , p. 5. Retrieved from NewspaperSG. 18. Chong, G. P. (1986, November 3).  Sex-change cases can get new ICs.   The Straits Times , p. 13. Retrieved from NewspaperSG. 19. Lim, S. (1990, May 20).  Legal poser over sex-change transsexuals who get hitched .  The Straits Times , p. 21. Retrieved from NewspaperSG. 20.  Sex-change pairs can’t marry . (1991, September 26).  The New Paper , p. 11. Retrieved from NewspaperSG. 21. Goh. T. T. (1996, January 26).  They were allowed to wed before.   The New Paper , p. 9; Gwee, E. (1996, August 30).  ‘I do’ – and no need to state gender at birth .  The Straits Times , p. 6. Retrieved from NewspaperSG. Further resources Cheow, X. Y., & Fung, E. (2007, March 7).  Born in the wrong body .  The Straits Times , p. 114. Retrieved from NewspaperSG. Chong, G.P. (1986, November 3).  Sex-change cases can get new ICs.   The Straits Times , p. 13. Retrieved from NewspaperSG. Fifth sex-change operation a success . (1972, September 11).  The Straits Times,   p. 6. Retrieved from NewspaperSG. Sex change man signs statutory declaration affirming that he is now a woman . (1972, April 16).  The Straits Times , p. 6. Retrieved from NewspaperSG. Tan, K. H., & Tay, E. H. (Eds.). (2003).  The History of Obstetrics and Gynaecology in Singapore . Singapore: Obstetrical & Gynaecological Society of Singapore: National Heritage Board. (Call no.: RSING q618.095957 HIS) Tan, W. L. (1971, August 31).  Man-made woman may not get marriage licence .  The Straits Times , p. 6. Retrieved from NewspaperSG. The information in this article is valid as at  2016  and correct as far as we are able to ascertain from our sources. It is not intended to be an exhaustive or complete history of the subject. Please contact the Library for further reading materials on the topic.

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7 Questions About Trans Issues in Singapore You Were Embarrassed To Ask

More than any other time in recent history, trans-related issues have seen increased discourse in Singapore. The year started with  a local transgender student , accusing the Ministry of Education of intervening in her hormone therapy treatment (HRT). Then, more recently, 24-year-old NUS undergraduate Dana Teoh has been thrust into public scrutiny for an  opinion piece  that centres around her frustration at the “woke movement” in Singapore. Teoh’s article has since drawn  mixed reactions  from the Internet, with some criticising her for a lack of sensitivity in addressing the issues faced by an already-marginalised group in Singapore—the transgender community.

Both issues highlight the increasingly pressing need to address a question that has yet to be dealt with properly in mainstream media: what is being transgender really like in Singapore? 

Mainstream awareness of transgender issues 

Local  attitudes towards LGBTQ issues remain largely conservative , according to the latest World Values Survey published in February by the Institute of Policy Studies. 

Even then, such surveys are not entirely representative of attitudes towards the trans community in Singapore. The  lack of official documentation  on the community – ranging from basic things like its estimated size to more critical issues such reporting on violence experienced – contributes towards a general lack of awareness of transgender issues. 

Poorly-understood issues that are indispensable from the trans experience include the transitioning process, the procedures one might choose to undergo, and the current laws in place for those seeking medical care for transitioning. 

This story aims to unpack these issues, and delve deeper in its implications for a community of individuals in Singapore that are slowly, but surely, emerging into the light of public discussion.

1) What is the history of the trans community in Singapore?

The transgender community has always played a part in Singapore’s history. 

The Bugis people, an Indonesian ethnic group, were one of the  first people to settle in Singapore  after the British began to transform the island into a trading hub. What is less well-known, however, would be the fact that the  Buginese community is known to be accepting of five types of genders . 

Besides the two genders that make up the “traditional” binary gender system, the Bugis people recognised the  calalai  (analogous to transgender men or masculine women), the  calabai  (analogous to transgender women or effeminate men), and the  bissu , who were androgynous shamans with both male and female characteristics. 

One of the first places the Bugis people settled in after arriving in Singapore was the area that stretched from Kampong Glam up to Rochor River. Today, areas occupied by landmarks such as the Bugis MRT station, Bugis Junction and Bugis Street pay homage to the district’s connection to the Buginese through their names. 

In an interesting coincidence, from the 1950s to the 1980s, the same area became home to a  vibrant community of transgender  individuals.  Bugis Street drew nightly crowds of foreign servicemen, sailors and tourists drawn to all the charms the area had to offer: alfresco bars, hawker stalls and of course, transgender women. 

For a brief blip in time, Singapore had more to offer than the sanitised shopping malls and the fancy skyscrapers that adorn Marina Bay, thanks to the transgender women who defined Bugis Street. The area has since been neatly cobblestoned over, and rebranded as another tourist-hub-cum-shopping mecca. One look at Bugis Street today, and one could be forgiven for being none the wiser about its riotous, colourful past as a hub for the local trans community. 

2) What does gender dysphoria mean?

Gender dysphoria, or the distress experienced when one feels a mismatch between their gender identity and biological sex, is typically brandished in debates about whether being trans can be considered a mental disorder. 

While gender dysphoria is categorised as a mental disorder, the condition refers to “the  distress  experienced from being transgender, and not the state of being transgender itself”.

For many experiencing gender dysphoria, ‘transitioning’, or adopting the outward characteristics (be it in terms of clothing, behaviour, or pronouns) of the gender identity they feel most comfortable with, remains one of the most effective ways to alleviate the condition. 

However, while it is common for trans individuals to experience some form of gender dysphoria, particularly when they have yet to transition in any way, not all of them do. 

To transgender woman Anabel Goh (not her real name), transitioning was simply a “procedure” for her to get a gender marker change—a decision that was “expedited” by the arrival of her enlistment letter for National Service, and not any sense of gender dysphoria. 

3) What’s the difference between sexual orientation, gender expression, and gender identity? 

To put it simply, gender identity refers to one’s personal, internal sense of being male, female, both, or neither. Being transgender boils down to identifying with a gender that deviates from the one’s biological sex. Non-binary people, or those whose gender identity lies outside of the binary (male or female) are also considered part of the trans community. 

“Being transgender is defined by how you  feel ,” stresses Goh. 

With this in mind, it’s easy to see how sexual orientation, or one’s pattern of emotional, sexual and romantic attraction to a particular gender, is entirely separate from gender identity. On top of being transgender, one can also identify as heterosexual, homosexual, or bisexual—just to name a few. 

Gender expression, however, can be a trickier concept to grasp. Contrary to popular opinion, the way in which one behaves or presents themselves, specifically within the standard categories of femininity and masculinity, does not necessarily have to align with one’s internal sense of gender identity. 

For example, a person who identifies as a heterosexual male can still ‘present’ femininely, such as by occasionally wearing skirts, putting on makeup on painting their nails. Physical appearance, as well as mannerisms and behaviour, all contribute towards one’s gender expression. 

Likewise, non-binary people can also vary their gender expression based on what feels most right to them. 

“Just because they are non-binary doesn’t mean they have to present androgynously (partly male and partly female in appearance),” says 19-year-old student Eljiah Tay, who identifies as non-binary.  

4) What is this pronoun thing?

For many heterosexual, cisgender individuals, it might be easy to feel like one is treading around landmines when learning the correct way to refer to trans individuals. 

For many trans individuals, however, being misgendered, or spoken or referred to with language that does not correspond with one’s gender identity, can worsen or excavate long-buried feelings of gender dysphoria. 

“When you misgender someone on purpose, you are affirming what  you  think they  should  be, instead of acknowledging who they are, and how they came to be who they are, at present,” says 24-year-old NUS undergraduate Lune Loh, who identifies as a transgender lesbian. 

“Correct pronoun usage [is] a mode of care—you  care  for your friends by referring to them in a manner they feel safe and comfortable with, that does not make them relive the trauma of a gender they do not feel right with,” Loh adds. 

5) What does transitioning mean?

While the concept of transitioning may seem straightforward, there are multiplicities to its meaning that often escape the attention of the wider community. 

For starters, transitioning does not always entail going under the knife, the injection of hormones or even a change of clothes. 

One can choose to transition in two primary ways: social, or medical. The former refers to publicly ‘affirming’ one’s gender identity, typically by adopting a new name and pronouns, or tweaking one’s mannerisms, behaviour and dressing to align with the gender identity that one feels at peace with. One can be considered to have transitioned, even without having gone through any form of surgery or hormone treatment. 

Medical transitioning, however, can range from receiving hormone injections, through a process known as hormone replacement therapy (HRT), to going for sex reassignment surgeries, or what is more commonly referred to as gender confirmation surgery in the trans community. 

Even then, surgeries vary in their level of complexity, with some transgender men choosing to remove their breasts (mastectomy, or ‘top’ surgery) and female reproductive organs (hysterectomy, or ‘bottom’ surgery), while opting to skip procedures for penis construction, such as  metoidioplasty or phalloplasty . 

Yap Wei Xin, a 27-year-old transgender man, is one such individual. At 23, he had flown to Thailand on his own for mastectomy and hysterectomy procedures, which had set him back roughly SGD$14,000 in total. 

For Yap, the multiple surgical processes required for the creation of a penis, as well as the relative lack of credible information and advanced technology for metoidioplasty and phalloplasty procedures, were reasons why he did not go through with either up till that point. 

The high costs attached to medical transitioning, be it for HRTs or surgical procedures, as well as the need for parental consent before undergoing most of these processes, make up some of the main barriers in the transitioning process of many trans individuals. 

Tay, who is interested in undergoing top surgery, cites not having come out to their family yet as one of the reasons for not having undergone any form of medical transition. 

In Singapore, the minimum age for one to  start HRT  without having to obtain parental consent first is 21, while those under 17 are barred from starting any form of HRT. 

Individuals are also required to undergo psychiatric evaluations to certify that they are of sound mind before they can begin HRT, or undergo any form of surgical procedures. This applies even if one were to  receive treatment abroad . 

6) What are gender confirmation surgeries?

Singapore is no stranger to gender confirmation surgeries. On 30 July 1971, a then-24-year-old Singaporean man made history as the  first person to successfully undergo a sex reassignment surgery  in Singapore. The operation gave rise to a few legal issues for trans individuals who have medically transitioned, such as the right for them to marry legally following a gender marker change. 

Although not all trans individuals opt for them, surgical procedures can be a crucial step in the affirmation of one’s gender identity and overall transition process. 

“Every day, I fall in love with myself; everyday, I live my fairy-tale life,” says Goh, on having transitioned in every way she sees fit. 

However, Loh believes more can be done towards providing local trans individuals with access to the estimated costs of the different “chemical and surgical means of transitioning”. 

The myriad procedures available, for both male-to-female and female-to-male procedures, as well as the differences and trade-offs between specific forms of procedures, remain poorly-documented in local health resources. 

Post-operation realities also remain an area of low documentation outside of transgender pages and support groups. For Yap, unsightly scarring was a concern that he struggled with after his mastectomy procedure. Beyond receiving treatments to reduce the scarring, there was “not much the doctor could do”. 

Hormone blockers and hormone therapy treatment

In December 2020, the High Court of the United Kingdom (UK) ruled to ban trans individuals under 16 from receiving access to “puberty blockers and cross-sex hormones”, on the grounds that those under 16 would be “unlikely to give informed consent” for receiving medical care aimed at helping them medically transition. 

The ruling came after 23-year-old Briton Keira Bell launched legal proceedings against a national gender health clinic for inadequate levels of investigation and therapy prior to her decision to transition to a male using puberty blockers. Also known as hormone blockers, puberty blockers put a pause on puberty-inducing hormones like estrogen and testosterone in trans children or teenagers. 

The UK High Court’s decision aligns with the current laws regarding HRT for trans individuals in Singapore, which place parental consent at the core of medical transitioning. 

On the age requirement of 21 years, Loh says: “[In practice,] many adults past [the age of] 21 are still at the mercy of their parents’ authority and rules. 

Thus, with regards to puberty blockers, I do think children and teenagers should be given the choice whether or not to use them… This must be done with [them] knowing all their terms, [as well as the] potential risks and consequences.” 

The age requirement also gives rise to a conundrum for trans children and teenagers who wish to transition medically, but have already gone through puberty and face a limit to how much HRT can reverse the process. 

The Crazy Plan to Send Solar Power From Australia to Singapore, Explained.

Having started HRT well into adulthood, Yap shares that while he did become slightly taller and hairier from his regular testosterone injections, it would be impossible for him to grow much much further as “[his] bones have reached the growing limit”. 

To circumvent this problem, some trans Singaporeans under 21 are procuring hormonal medication online , which cannot be proven to be authentic or safe for consumption. 

To Tay, the conversation about hormone blockers should be directed towards addressing “structural concerns”, such as the lack of adequate information on gender identity issues, and providing young trans individuals with the resources they need to make informed decisions, instead of debating about whether they are capable of making such decisions. 

Besides helping trans individuals make more informed decisions about their gender identity, providing access to more inclusive education to all can also help to debunk certain misconceptions held by non-trans individuals, such as the notion that these decisions are “irrational”, notes Tay. 

7) Why should I care about Trans issues?

Life after transitioning is not a bed of roses for the trans community.

The use of shared, gendered spaces remains one of the biggest challenges faced by trans individuals who transition in ways that do not immediately translate to a perceivable change in their outward appearance. 

In Singapore, there are currently no laws in place to enforce sex-specific use of public restrooms. However, this does not exempt trans individuals, particularly those who appear to be androgynous or are in the midst of receiving HRT, from adverse public reactions, ranging from microaggressions to even censure, when using public restrooms. 

Yap recalls feeling apprehensive of making the switch to male public restrooms, even after his gender confirmation surgeries. For as long as one month after his surgeries, he had stuck to using female restrooms. 

“I do get stares from other ladies in the restroom—some even ask me whether I am a girl,” says Yap, who would just “go with it and say yes”, for fear of being probed further. 

According to Yap, a push from one of his friends is a reason why he eventually found the courage to start using male restrooms. 

“I was still going back and forth between the ladies’ and the gents’ [restrooms], until my friend found out and said: ‘You’re a guy, right?’ I said yes, and she said: ‘Okay, then from now on don’t you dare go [to the] ladies; I will judge you!’,” Yap laughs. 

At that point in time, his voice was also getting deeper from the HRT he was receiving, giving him the confidence he needed to start using men’s restrooms. 

With so many considerations in mind, the only option that remains for trans individuals still in the process of transitioning medically is often to simply opt for unisex, wheelchair-accessible restrooms—an option that is not always available. 

At Loh’s residential college at NUS, there are only about two to three wheelchair-accessible bathrooms in the whole building. As part of a special housing arrangement with the college, she is allowed to use such bathrooms, but with a catch—she still has to stay on the mixed-gender floors of the college, and on the ‘male’ side of the floor. 

“There’s no way I can be placed on an all-female floor—[the] NUS housing policy would not accede to that,” explains Loh. 

Transitioning can also be a complicated and often painful process for those still receiving education in government-funded schools. 

Tay, who recently completed their studies at a local junior college (JC), recounts how they used to get into trouble at school for their reluctance to don their skirt, which remains part of the gendered uniforms that school-going students in Singapore, from primary school all to the way up to JC, are required to wear. 

To avoid wearing a skirt, Tay would try to be in their Physical Education attire as much as possible. Even then, they would still be chided by more “picky” teachers and forced to put on a skirt. 

In Secondary Four, a teacher of Tay’s had addressed them indirectly in front of hundreds of other students in a lecture theatre. 

“[She] said: ‘As long as you’re wearing a skirt, I’ll take that you’re a girl. If you want to be a guy, wait for your next life.’ 

To face transphobia from [a teacher that I respected] really took me aback, and destroyed my trust [in] anybody with authority in the school,” Tay shares. 

Working towards a more trans-inclusive society 

Transgender individuals have always been a part of our society. Despite shifts towards more progressive values in recent years, more has to be done to provide trans individuals in Singapore with the avenues to voice their very real concerns, born from their very real “experiences, histories, traumas, dreams, and desires”, as Loh puts it. 

According to the NUS undergraduate-led research report entitled  Cisgender Students’ Attitudes and Beliefs towards Transgender Individuals and Trans-Inclusive Efforts , there are three main aspects to building a more trans-inclusive community: Model, Educate and Collaborate. 

Besides being changemakers in terms of trans-inclusive efforts like adopting the use of trans individuals’ preferred pronouns, as well as making strides to include trans voices in policymaking, the report advocates for correcting common misconceptions about the trans community—which is exactly what this story hopes to achieve.

Ignorance breeds misunderstanding, which in turn devolves into hate and violence if left to fester. 

The trans community may face many battles in their daily lives, but this is one that the rest of us can ride alongside with them into—if we could just care to ask, and listen.

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Social Transition

Social transition is the process by which transgender people publicly affirm their gender identity.

This commonly involves changing your names and pronouns, as well as presentation (including clothing and other external gender cues, like voice and mannerisms).

Socially transitioning can be a fairly daunting and complicated process for trans people. Some choose to socially transition shortly after they come out, while others who plan to go on hormone replacement therapy may choose to wait until they look more masculine or feminine. That usually eases the process, especially when meeting new people who may automatically read a trans person as the gender they present as.

On pronouns: Many non-native English speakers in Singapore – even those fluent in English – have problems with gendered pronouns, since languages like Chinese, Malay, and Tagalog use gender-neutral pronouns in speech. Some may constantly use the wrong pronouns even when referring to cis people. They may thus find it difficult to remember to use the right pronouns for you, even if they accept your gender identity. One upside to this is that Singaporeans are used to people who get pronouns wrong; being misgendered doesn’t necessarily mean you might be outed as trans. If you know someone like this, and know that they do accept you, it can help to focus on that acceptance and other ways they affirm you as your gender, and brush off any wrong pronouns the same way you would when they misgender cis people.

Socially transitioning in life

Socially transitioning in your day-to-day can mean more than just changing your name and pronouns. You may wish to also change your gender presentation and your online presence, and these will ultimately have widespread ramifications.

Changing your presentation in person

There are several ways you can change your gender presentation as a trans person. These include aesthetic changes like facial hair removal or hairdressing services.

It’s important to have a view of what you might want. If you need or want to be fluid in your presentation (to pass as your birth gender in certain situations), you can opt to have shorter hair, or a hairstyle that can at times pass as your birth gender.

A moodboard helps here. Here’s an example for short androgynous hair by a transfeminine person; having a moodboard means that you can communicate exactly what kind of hair you want and what you are comfortable with.

Hair for transmasculine people

Shorter hair isn’t necessarily better if you’re seeking to be read as male, especially when you’re pre-transition, not transitioning, or early in your transition.

Short hair can emphasise feminine facial features and head shapes, and are likely more suitable for non-binary transmasc people aiming for a more androgynous look. Slightly long masculine styles may thus work better, but it is recommended that you have a more squarish or angular look rather than a rounded cut.

It is best for you to transition to a barber if you are read as male if you’re comfortable with it; you can reach out to us if you’re looking for trans-friendly barbers.

Hair for transfeminine people

If you’re a transfeminine person, you should keep your hair as long as you can. This would mean giving your stylist enough material to work with.

You should have your hair trimmed periodically every three months or so, to ensure that it’s structured and textured in a way that you want to look when it grows out. For many people, transitioning from short to long hair would mean an awkward stage where your hair looks kind of flat. Let your stylist know if you’re intending to grow it out.

If you’re presenting as male, people around you will probably ask when you would cut your hair; if you’re relatively independent and not in school or National Service, just say you don’t have the time.

Reach out to us at [email protected] if you’re looking for trans-friendly hairdressers. If you or your business welcomes trans clients, do let us know and we’ll add you into our private directory.

Facial hair removal

Trans women and transfeminine people often seek facial hair removal, and if you’re one of them, you can go to an affirming aesthetician for hair removal.

Though these services are available through the public health system, they are usually not eligible for subsidy and cost around $450 per session; public providers also tend to be inexperienced with treating trans patients.

Aestheticians in Singapore are able to provide electrolysis, IPL (intense pulsed light) and SHR (super hair removal) services.

Aestheticians usually do not provide for laser hair removal as they require additional licensing.

For a trans-friendly provider, you can contact Alex and team at  HairFreeSG .

If you are an aesthetician that welcomes trans clients and wish to be added on our list, let us know by reaching out to us.

Binding safely

Singapore is ridiculously hot and humid, and thus binding can seem like a daunting yet necessary task that people with breasts need to get through.

Binding should not hurt, cut your skin, or prevent you from breathing. Do not buy a binder that is one size too small in the hopes that it will flatten your chest – binders are already designed to be very tight when they fit properly, and getting one that’s too small will cause severe discomfort and injury.

As a rule of thumb, do not spend more than 8 hours binding. Let your body get used to the binder slowly – spend two hours first, then four, then six – and remember to take breaks. Some people might be able to handle wearing a binder for very long, while others can’t make it to 8 hours – it is highly dependent on your body!

Naturally, don’t wear a binder while doing strenous activity, or doing anything that requires a lot of lung effort as you’re basically compressing your lungs. Do not wear them while choir singing, playing a wind instrument, or when sick with a respiratory illness; you’ll get out of breath and it will be difficult to catch your breath.

Transbefrienders run a binder redistribution project – click here if you need a binder .

Going to the washroom

At some point in your transition you may have to switch the public restrooms you use. Singapore presently does not have any specific laws about sex-specific usage of public restrooms, but you may have to deal with other people’s reactions.

The safest option for most – especially if you are perceived as androgynous or ambiguous, or if you are genderfluid – is a unisex or handicapped stall. Some public buildings in Singapore have handicapped stalls inside the two gendered restrooms, so you may have to take note of that.

As a general rule, you are much more likely to be stared at or confronted in the ladies, but seriously hurt in the gents if people figure out that you are trans and respond badly.

Whichever toilet you choose, act like you belong there and people will assume you do. After all, you’re there for a fairly simple and normal objective – to relieve yourself – and there’s no need to feel guilt or fear over not belonging there. Go in, use the the toilet, wash your hands, and leave. You’re less likely to be seen as suspicious if you look like you belong there, as opposed to if you’re visibly nervous and scared.

Remember that even with a small trans community, Singapore is a still very diverse place when it comes to gender presentation. Masculine/butch cis women still use the ladies, and feminine-looking cis men still use the gents! You might just look like someone who is gender non-confirming, and that is relatively acceptable in society today.

Some more tips if you don’t feel safe or confident:

• Use the toilet before you leave the house.
• Try a less busy restroom if you can. Washrooms are often emptier on higher levels in a mall, for instance.
• Have someone accompany you, and either have them stand outside and wait, or just go with you if you need.
• Stare at your phone while you wait for a stall. Everyone’s scrolling anyway, so this will tempt others to check their own phones, and they won’t be looking at you.
• If you don’t feel safe speaking, try not to do so in the washroom.

Coming out and transitioning online

The hard part about changing your name is telling everyone about it. Depending on how you feel about being known as your previous name, how many friends you’d like to tell, or how you want people to know, you may choose to deal with this in different ways.

If your current name is something that doesn’t remotely resemble the name given to you at birth, it might be good to build new social media accounts and networks. This might not work if you depend on them for work, or for communicating with family members.

You do not need to be on HRT or even legally change your name before socially transitioning; a change of name is just that, a change! You can try out new identities amongst friends or online spaces that are more accepting.

Dealing with pre-transition photos on social media networks

If you wish to keep your transition private, it would be helpful for you to delete all instances of pre-transition photos on social media networks. If you would like to store them, a good place would be offline on a hard disk or thumb drive or on your phone, as long as you have appropriate privacy safeguards.

This is to largely prevent people from outing you or knowing outside your control. It gets easy to find previous photos of yourself, especially if your younger self or if your relatives were more loose with their social media privacy. You should do the above before you come out in public.

Most social media instances will have a function to download the information you have put up and to delete them from servers.

Social media safety

At some point in your social transition, you will have to try and figure out who you’re comfortable with coming out to.

We generally encourage trans folk to connect with the people closest to them, but if there are some people who make you feel unsafe, or if you are not ready to come out to some people, you can opt to block or disconnect from them.

Socially transitioning at work

Depending on where you’re at in your career, you may have to deal with many different things when you socially transition.

Transitioning early will have obvious benefits of enabling a professional network and a career without the messiness of transition. But it may also mean some difficulty in obtaining a job, especially if you are not able to legally change your gender.

Take a look at our Career Planning page for more details.

Socially transitioning in school

School systems generally vary in how they accept trans and queer students, and some school systems may allow you to socially transition without changing your name.

MOE policy has generally been one of not encouraging transition or visible queerness, especially in secondary schools and junior colleges.

Still, some junior colleges may be more welcoming (culturally) than others, with people accepting your chosen name and pronouns.

Universities and polytechnics are generally more accepting spaces, and the Inter-University LGBT Network is a good space to start out if you need college-specific information about socially transitioning.

Disclaimer: Information on this site is for general information only. It does not constitute legal or medical advice and is not a substitute for obtaining advice from a qualified professional. We do not represent or warrant that this information is suitable, reliable, complete, accurate or up-to-date.

For Singapore's LGBTQ Community, Legal and Procedural Hurdles Linger

When 21-year-old Alexander Teh flew from Singapore to Bangkok with his parents earlier this month, he expected to have the first of his female-to-male gender reassignment surgeries: a scheduled bilateral mastectomy. Instead, his surgeon sent him to see a psychiatrist at a nearby hospital. “He said he was sending me to see a psychiatrist for my parents, to ease them into the process,” Teh explained.

The meeting went well at first, until the psychiatrist asked Teh whether he was attracted to men or women. “I said I was attracted to guys, and she said ‘Interesting,’ so I thought it wasn’t an issue,” Teh said. But at the end of the meeting Teh was told he’d have to go through another series of psychological tests before he would be allowed to have the surgery.

“The psychiatrist said it was quite clear that I had gender dysphoria, but she was confused as to why I would choose to like guys and not girls,” Teh said. “I told her, I didn’t choose it, it’s just the way it is.”

The psychiatrist told Teh he would still need to take further tests, and scheduled the tests for a date after Teh and his parents had planned to leave Bangkok. Teh ended up returning to Singapore without having the surgery.

For many transgender men and women like Teh, living in Singapore and navigating the process of transitioning can often involve a series of legal and procedural hurdles that can create challenges beyond simply fighting for social acceptance from family, friends, and colleagues.

RELATED: Vietnam's LGBTQ Movement Is in Full Bloom

In Singapore, a person cannot have one’s gender marker legally changed on official documents without first undergoing gender reassignment surgery and sterilization . This is a much stricter policy when compared to countries like Argentina or Denmark , which require no surgery or any type of medical verification to have a person’s preferred gender legally recognized by the government.

“Personally, I can see why it’s a requirement,” Teh said of Singapore’s policy. “But for trans people who don’t have the means for these surgeries, whether for financial or health reasons, [the requirement] hinders the quality of life for these people. Because them having these reproductive organs doesn’t make them any less of the person that they identify as.” He also noted some people simply don’t feel the need to undergo surgery as part of their transition.

For Teh, it was a step he wanted to take, and he decided to travel to Bangkok for his surgery because the specific procedure he wanted wasn’t performed in Singapore. He didn’t expect that his identification as a gay man to the psychiatrist would have created a hurdle so early on in the process, preventing him from having the surgery as originally planned.

If anything, Teh had prepared himself for the legal hurdles being a gay man might cause after his gender marker was legally changed to male, since the act of sex between two men is still criminalized in Singapore and punishable with up to two years in prison, as stated in Section 377A of the Penal Code .

“It’s not actively enforced,” Teh said of the law. “But it is a concern that this law could be used against people, not just myself but other people in Singapore as well, because it’s there.”

RELATED: LGBTQ Activists in Brazil Use Social Media to Spread Awareness, Acceptance

Roy Tan has been archiving Singapore’s LGBTQ history for nearly two decades, and says laws like Section 377A can have an outsized effect on the lives of LGBTQ individuals living in Singapore, even if not actively enforced.

“The law has an enormous influence over how the population views homosexuality, since most policies in Singapore are top-down,” Tan explained. “Once you change the law, public opinion regarding homosexuality will change accordingly.”

Tan added Section 377A specifically affects censorship and sex education. “There can be no positive portrayal of LGBTQ people because of censorship policies , and these are backed by the criminalization of gay sex,” Tan explained. “Any mention of gay rights, even by Ellen DeGeneres or President Obama is regarded as promoting homosexuality and has to be censored .”

Sujith Kumar, cofounder of the Purple Alliance, an LGBTQ organization in Singapore, believes Section 377A is one of the biggest barriers to progress for the LGBTQ community in the country. “How do we move forward when all mainstream society hears is that being gay is somehow against the law, against the ‘family’ and against ‘nature’?” he asked.

RELATED: Kenyan Artist Brings Visibility to Nairobi's LGBTQ Community

The constitutionality of Section 377A has been challenged in recent years by two high profile cases brought on by gay men, but both cases failed to result in the law being repealed . According to a report provided to the United Nations by the government of Singapore in October 2015 , the law remains because “segments of Singapore society continue to hold strong views against homosexuality for various reasons including religious convictions and moral values.” Although the report also stressed that “while Section 377A is retained, the Government does not proactively enforce it.”

How much the law will directly affect Teh once his gender marker is legally changed to male is not something he’s entirely clear of, but it’s something he’d rather not have to think about as he deals with the other hurdles of transitioning. “I think that if it’s not being actively enforced then you should just do away with it,” Teh said. “It still creates a hostile environment for gay men in Singapore.”

But this is something Teh will deal with at a later time, since for all legal purposes the government of Singapore still considers Teh to be female. He is still determined to continue the process of his gender reassignment surgeries and hasn’t let the road block caused by his experience with the psychiatrist in Bangkok deter him. If anything, he’s inspired to work harder toward his own goals of working in mental health once he graduates college.

“I hope someday to be qualified enough to specialize in LGBTQ mental health care, so in the future I can provide better help for trans people specifically,” he said. “I think no one should have to suffer to get to where they want to be, so if I could do something to change that then that would be great.”

Follow NBC OUT on Twitter , Facebook and Instagram .

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Follow-up study of female transsexuals

Affiliation.

• 1 Gleneagles Medical Centre, KOK & Tsoi Psychiatric Clinic, Singapore.
• PMID: 8579306

The aim of this study was to examine the social and sexual adjustments of Singapore female transsexuals following sex reassignment surgery. All female transsexuals who were operated on since 1989 were interviewed. There were a total of 17 transsexuals with a mean age of 29 years (range, 20 to 41 years) at the time of inception. Before surgery, all were single. After surgery, 6 out of 11 subjects had married abroad. Before surgery, some had problems with identity cards, passports, travelling and work which were resolved with surgery. They were better accepted and had better sexual adjustment after surgery. All were satisfied with the change in sex, but only 65% were satisfied with the surgery. Only 59% said they were willing to undergo the operation again. After a test case in court, they were unable to marry in Singapore. Their primary motive to undergo sex reassignment surgery was to become a member of the opposite sex, so that they could be recognised socially and legally.

• Follow-Up Studies
• Genitalia / surgery*
• Marital Status
• Patient Satisfaction
• Sexual Behavior
• Social Adjustment
• Surgery, Plastic*
• Transsexualism* / psychology

Sex reassignment surgery in Singapore

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Sex change operations or sex reassignment surgery is more appropriately referred to as gender-affirming surgery , a term which started to be used in the late 20th and early 21st centuries as a more inclusive and respectful alternative. The term reflects the idea that surgery is not changing one's gender, but rather affirming one's gender identity . It also acknowledges the diversity of transgender and nonbinary people who may seek different types of surgical procedures or none at all.

• 1.1.1 Patient and diagnosis
• 1.1.2 Operation
• 1.1.3 Marriage plans
• 1.1.4 Impact
• 1.2 Second sex change operation
• 1.3 Prof. Ratnam urges Government to allow post-op transgenders to change particulars on ICs and passports
• 1.4 First female-to-male sex-change operation
• 2 Documentary
• 3.1 Closure and reopening
• 3.2 Final closure
• 4 Dwindling cases of sex reassignment surgery in Singapore
• 6 References
• 7 Acknowlegdements

Early sex reassignment surgery [ ]

Prof Benjamin Sheares .

Singapore 's second President, Benjamin Sheares , was a well known and distinguished O&G surgeon who headed the Department of Obstetrics and Gynaecology at Kandang Kerbau Hospital in the 1940s and 50s. One of his main contributions to medicine was a technique to create an artificial vagina for patients born without one. A modification of Sheares' vaginoplasty technique ( Sheares vaginoplasty ) was later used by pioneering gynaecologists in the same department like Prof. S Shan Ratnam to perform male-to-female sex reassignment surgery (SRS). Ratnam later trained other younger surgeons like Assoc. Prof. Arunachalam Ilancheran and Ratnam's nephew, Dr. C Ananda Kumar to perform the procedure. The first such operation in Asia took place in Singapore in July 1971. However, before patients could go under the knife, they first had to subject themselves to an exhaustive battery of tests and be given a clean psychological bill of health by Singapore's chief academic psychiatrist Prof. Tsoi Wing Foo of the Department of Psychological Medicine , National University of Singapore . Psychiatrists in Singapore required transgender patients to live and dress as a member of the opposite sex for at least a year before certifying them suitable for sex reassignment surgery . Half of those seen by Prof. Tsoi were not deemed suitable for the operation. His counselling sessions also helped to make transsexuals aware of the difficulties they might face after they have had the operation performed.

First sex change operation [ ]

The first sex change surgery in Singapore was successfully performed on Friday, 30 July 1971 at Kandang Kerbau Hospital [1] , [2] , [3] . The operation involved a 24-year-old male-at-birth individual and was the first procedure of its kind performed in Singapore as well as in Asia. There had been previous “sex-change” operations performed locally, but these mostly involved patients who had both male and female genitalia ( hermaphrodites ) and the removal of one set of genitalia. The 1971 operation was regarded as a first because it involved a surgical conversion aimed at functionally changing a person's sex.

Patient and diagnosis [ ]

The patient was a 24-year-old Singaporean citizen of Chinese heritage. Her name was initially kept secret, but her background was later made public in a book, which also revealed her name as "Shonna". The eldest son in a family of five with two younger sisters, she lived in constant fear as a child because her father was a hot-tempered and aggressive dentist who was often physically violent with his wife. This caused her much psychological trauma as she witnessed her mother suffer multiple beatings at the hands of her father. Stitches and trips to the hospital became commonplace in a household that was supposed to be a bastion of safety and security. Eventually, Shonna moved to her grandmother's abode although she still maintained frequent contact with her mother and two younger sisters. Her grandmother raised her, dressing her up as a female and it was through the elderly woman that Shonna was adopted by the goddess Guanyin (Goddess of Mercy in Buddhism ) at their nearby temple. In her teenage years, she associated with other cross-dressers before frequenting the transvestite and transsexual scene at Bugis Street as an adult.

Shonna ’s teenage years were no better than her childhood. At school, she was performing abysmally and was unsuccessful in her attempts at obtaining a secondary-level certificate. It did not help that she was often bullied for her appearance. Male students would take her to the movies and force her to masturbate them. Her father tried to get her to work as an assistant at his dental clinic for a while, though this was short-lived. After embarrassing remarks about Shonna ’s ambiguous gender, the dentist banished her to perform chores at home. A year before her father died in 1966, Shonna started looking for work on her own. From the age of 16, she first worked as a sales assistant, then as a housemaid for a European man whom she had an affair with and who subsequently forced her to leave the job. She then found work in a bank. Her next occupation was a public relations officer in a hotel. During this stint, Shonna entered a Miss Beauty contest and won the second prize. As a result, she was allowed to model part-time for advertisements and was soon featured in Her World magazine. It was also during this period that Shonna joined a cabaret where she was known as "Mama Chan" and started a social escort service.

While her professional life had started to take off, her personal life was still in a shambles. The woman wanted to be a serious model, get married to a man and settle down. These were things that her physical body and the prevailing laws of the era would not allow her to do. Desperation drove her to attempt suicide twice and left her on the verge of another attempt to kill herself. This was when she decided to seek Professor S Shan Ratnam ’s help. Having lived as a woman for some time, she first consulted Ratnam, then senior lecturer in the University of Singapore ’s Department of Obstetrics and Gynaecology, in 1969. She was suffering sexual and emotional problems, which had led to two suicide attempts.

In later years, Ratnam recounted his experience of seeing the young woman sitting outside his office: “She was so attractive, I couldn’t take my eyes off her.” Deep down, he knew that something was wrong – the women who would come see him this late and alone usually wanted an abortion or help with an awkward situation. Nonetheless, he invited the woman into his office and sat her down. “Professor, I want a sex change operation,” she said very frankly. Surprised, he leaned back on his chair and responded, “Why come to me? I don’t know anything about transsexualism”. At that point, sex change operations were virtually unheard of around the world, and there was little medical literature surrounding the topic.

“Professor, you have the right to say no, I’ll accept it. But you may not see me alive again,” she said as she pulled down her shirt to show a large cut mark across her neck. Not knowing what to do, the professor referred her to the psychiatric clinic, hoping that she would not come back. Ratnam explained to her that he had no experience in sex change surgery , but she persisted and continued to visit his clinic weekly. Every evening, at around six, she would wait outside Ratnam’s office, asking him if there were any updates on her case. Eventually, the psychiatrist, Dr Tsoi Wing Foo , wrote back to Ratnam, telling him that Shonna was not only able to give informed consent for the operation, but would also greatly benefit from it.  She had been diagnosed with gender dysphoria , which meant that she possessed a continuous sense of inappropriateness about her anatomic sex and a desire to discard her genitalia and live as a member of the opposite sex. A total of six to nine months of medical and psychiatric tests had to be carried out before the Shonna could undergo the operation. After the results were reported, Ratnam had no choice but to give in. He began to research the subject of transsexualism and sex reassignment surgery . In preparing for what was to eventually be Asia ’s first sex change operation , Ratnam referred to a technique created by Singapore’s President (and former professor of gynaecology) Benjamin Sheares . Called the Sheares vaginoplasty , the groundbreaking technique was originally used to create an artificial vagina for those born without one. Ratnam adopted and modified this technique for in sex change operations . He then familiarised himself with the surgery by practising on cadavers.

Shonna underwent a psychological analysis by a team of psychiatrists who confirmed that she was a transgender woman who required surgery. A diagnosis of transsexualism required that the patient possess a continuous sense of inappropriateness about his or her anatomic sex, a desire to discard his or her genitalia and live as a member of the opposite sex, and the absence of physical intersex symptoms or genetic abnormalities. Furthermore, his or her gender confusion ( gender dysphoria ) must not be caused by other disorders such as schizophrenia . The patient was also cautioned that the surgery would be irreversible, potentially involved a number of complications and required a prolonged follow-up period.

As Shonna’s operation loomed, Ratnam reached out to the Ministry of Health to seek legal clearance. The ministry granted it as long as the procedure was done in secret and without publicity. Nurses, doctors and other workers at the hospital were informed about the instructions. After consideration of the Shonna’s psychological profile and the medical expertise involved and with the approval of the ministry, it was decided to proceed with the operation.

Operation [ ]

On Friday, 30 July 1971, the operation was performed by Ratnam and two other top surgeons from the University of Singapore ’s Department of Obstetrics and Gynaecology, Associate Professor Khew Khoon Shin and plastic surgeon Mr R Sundarason . Photography of the operation was not permitted and everything was kept secret. That was until a medical student in the operating theatre telephoned his sister, who was then a reporter, to tell her that history was being made. The secret was so badly kept that by the time Prof Ratnam returned to his office after the operation, his phone was constantly ringing. He described the 3-hour operation as a success, with an uneventful post-surgery recovery.

For the first two to three years after Shonna’s operation, Ratnam conceded that he was very worried. Considering that sex change operations were relatively new, he was fearful that patients would regret and resent the irreversible procedure after a few years. Even his own colleagues were talking behind his back about the surgeries. However, as soon as he started getting letters from patients (some calling him a “saviour”) thanking him for his help, he knew he was doing the right thing. According to him, even recovered cancer patients were not as joyous as these individuals. This conviction led Ratnam to establish the Gender Identity Clinic specialising in sex reassignment surgery at the National University Hospital in 1991.

Marriage plans [ ]

After the operation, Shonna felt fine and was to leave hospital for home because she had marriage plans [4] . Speaking from her Kandang Kerbau Hospital bed, she said she was engaged to an executive who worked in the same office building as herself. Reclining on her hospital bed and peeling an apple, she said she was feeling fine and waiting to be discharged “very soon."

The 24-year old stenographer also said she would be going back to work on her discharge from hospital. Shonna was subsequently put on hormone replacement therapy and became functionally a woman, with the exception of being unable to conceive or menstruate. She later married a Frenchman and owned a travel agency in Paris , before moving to England .

The July 1971 operation paved the way for sex change surgery in Singapore and in the region. Singapore’s first sex change operation on a woman took place three years later, between August 1974 to October 1977 (female-to-male conversions are a more complex process and involve several surgical stages). In the 1970s and 1980s, hospitals in Singapore accepted numerous sex change patients from other Southeast Asian countries, with foreigners making up around half of all surgeries performed."

Second sex change operation [ ]

Singapore's second sex reassignment surgery was also performed successfully in October 1971 at Kandang Kerbau Hospital by a team of doctors — which included a psychiatrist — headed by Prof. S Shan Ratnam of the University of Singapore’s Department of Obstetrics and Gynaecology [5] . The second patient was a 25-year-old bachelor, who was said to be working in the hotel industry. Like his predecessor, he had been using a woman's name and had dressed as a woman for many years.

He had been “unhappy” about his condition and had consulted a private doctor soon after reading about Singapore’s first sex change operation on 30 July 1971. He was referred to the hospital in mid-October 1971 and the operation, lasting about three hours, was performed a day after he was warded. He was also followed up with hormonal treatment to ensure permanency of the change.

Prof. Ratnam urges Government to allow post-op transgenders to change particulars on ICs and passports [ ]

On 25 November 1973, Prof. S Shan Ratnam made a speech during the International Y's Men's Club lunch meeting at Hotel Equatorial imploring the Government to allow post-operative transgender Singaporeans to change the particulars on their personal documents so that they could have a better chance of leading normal lives.

A policy directive was subsequently instituted at the National Registration Department to enable them to change the legal gender stated on their national registration identity cards (NRIC) (but not their birth certificates) and other documents which flowed from that, such as their passports.

Of course, one would not expect just one speech by Prof. Ratnam to accomplish this coup which saw Singapore take the lead worldwide with respect to transgender rights. The LGBT community and general public did not know how this was achieved until Ratnam's protege, Assoc. Prof. Arunachalam Ilancheran revealed during a television discussion forum on thirunangai ( Tamil male-to-female transwomen) in 2012 that Ratnam lobbied the Government quietly behind the scenes [6] :

First female-to-male sex-change operation [ ]

In October 1974, a team of O&G surgeons from the University of Singapore carried out Singapore's first sex reassignment surgery on a woman at Kandang Kerbau Hospital [7] . The operation was the first-ever performed on a woman in the region. It was done in three stages and was described as “highly complex” by medical specialists.

The lengthy procedure began in about August 1974 and the surgeons from the University of Singapore’s Department of Obstetrics and Gynaecology again led by Prof. S Shan Ratnam successfully completed the first two stages. Two months later, they carried out the final phase on the woman, who was a Singapore citizen and a Chinese, aged 24 and single. Her name address and other details were kept secret.

Prof. Ratnam also opted to remain silent about the operation. A Ministry of Health spokesman said, “Prof. Ratnam is unwilling to discuss any such operation as he to unable to see the reasons for doing so. This Ministry concurs with his views." Ratnam did, in the past, speak on two male-to-female sex change operations and the problems patients faced. The patient, believed to have been educated in a mission school, had a girlfriend. She was to understood to have been feeling very uneasy and desperate for several months. She was taken through a full investigation, including a thorough psychological analysis by at team of psychiatrists, to determine if she was a “true" transexual who could not bear being a woman at all.

It was only after very careful consideration, including a thorough medical study and psychiatric endorsement — and with the Ministry’s approval — that the operation was given the green light. Once the operation is successfully completed, she applied to the Attorney-General's Office for a change in legal status from "Miss" to "Mister."

Documentary [ ]

In a groundbreaking and extremely graphic mondo documentary entitled " Shocking Asia " produced in 1974, transgender women in Singapore revealed the most intimate details about their lives and sex reassignment surgery done by pioneering surgeon, Prof. S Shan Ratnam who also granted an exclusive interview. The operation itself was shown in great detail [8] :

Ratnam is believed to have been unhappy with the final tenor and packaging of the documentary, which can be regarded as a mondo film , as he was probably led by the producers to believe that it would be a scientific, non-sensationalistic project.

Gender Identity Clinic [ ]

The Gender Identity Clinic ( GIC ) and Gender Reassignment Surgery Clinic were set up at the National University Hospital in the early 1990s, two decades after Singapore's first sex change operation was done at Kandang Kerbau Hospital in 1971 by pioneering O&G surgeon and head of the Department of Obstetrics and Gynaecology, National University of Singapore , Prof. S Shan Ratnam . The GIC was headed by Ratnam himself until his retirement in 1995, after which leadership passed to his nephew and protege, Dr. C Anandakumar . Owing to the existence of these clinics and the skills of their staff, Singapore was one of the world leaders in gender-affirming surgery for 30 years, performing more than 500 such operations. This gave a new lease of life to many transgender individuals whose bodies did not match their gender identity .

Closure and reopening [ ]

In the early 2000s, the National University Hospital 's Gender Identity Clinic ( GIC ), the offshoot of the Department of Obstetrics and Gynaecology at Kandang Kerbau Hospital formed a decade ago, was the only facility for sex change operations in Singapore. Although it helped to build Singapore's reputation as a top destination for sex reassignment surgery over the past 30 thirty years [9] , its exact location within NUH and the services it provided were kept confidential because of the sensitivity of the more vocal religious fundamentalist segments of Singapore's population to sex reassignment surgery. Since 1971, when the late Prof. S Shan Ratnam performed Singapore's first sex change operation, there had been 500 such procedures, an average of 17 a year. But the GIC had done no male-to-female operations since 2001. Since September 2001, it had performed only four female-to-male operations.

This was because the Ministry of Health had asked hospitals to phase out sex-change surgery in the late 1980s for fear that hospital staff might be exposed to HIV . It was also reported then that the Ministry had not considered sex-change surgery as a life-saving procedure. These objections were lifted in 2001.

The general public could not find any information on the GIC on NUH 's website and it was extremely difficult to interview its then consultant, Dr. Arunachalam Ilancheran . Dr. C Anandakumar , who was the specialist-in-charge at the GIC from 1995 to 2001, recounted how, during his time, consultations with transgender patients could only be done on Saturdays and after office hours, as NUH had very little interest in encouraging sex reassignment surgery. Transsexuals would also need to book themselves into single-bed 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. However, he conceded that the situation may have changed and added that the clinic had served its purpose well.

In reply to queries from The New Paper , an NUH spokesman said, "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."

Transwoman Leona Lo completed her psychiatric assessment in Singapore but elected to have her surgery performed in Bangkok . She felt that the lack of information about the GIC deterred transsexuals like herself from having the operation done here. She said, "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 transgender patients were flocking to Thailand. Transwomen were still seeking help from the GIC.

In April 2001, the Gender Identity Clinic at the National University Hospital , which was the last hospital in Singapore where sex change operations were performed, closed without any fanfare. The official explanation was that the gynaecologist in charge, Dr. C Anandakumar , had left for private practice, and without him, the clinic did not have the skills to perform SRS. However, as early as 1987, the Ministry of Health had been directing hospitals to stop doing such operations on foreigners. It also discouraged them for Singaporeans, saying, "the increased danger of AIDS with such patients poses unnecessary risk to hospital staff". However, some believe that the increasing number of Christian doctors filling the administrative ranks of Singapore hospitals over the past decades had a part to play in its shutting down as cross-dressing and sex reassignment are proscribed in the Bible .

This dismayed transgender people seeking to have their operations performed locally. The online edition of the now-defunct newspaper Project Eyeball carried out a survey in June 2001 asking, "Should sex change operations be resumed in Singapore?" 39% of respondents said, "Yes, they are people with valid medical needs, like infertile couples" and 35% said, "Why not? It is legal here, as are transsexual marriages". The results showed that Singaporeans were generally quite supportive.

In June 2001, a petition organised by Jael [10] , the founder of the transgender group " FTMs in Asia ", urging the re-opening of the Gender Identity Clinic garnered 60 signatures [11] . When asked by The New Paper 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."

The transgender community's petition was successful, with the clinic discreetly and fully resuming it services in 2003, helmed by Dr. Arunachalam Ilancheran . However, owing to the discrimination against transgender people in Singapore even within some segments of the medical community, the high financial outlay involved and the necessity for psychological clearance, many preferred to have their operations performed sans the hassles in Bangkok , which had by then become the premiere centre for sex reassignment surgery (SRS).

In early August 2001, Singapore's pioneer sex reassignment surgeon and co-author of the book " Cries from within ", Prof. S Shan Ratnam , passed away from pneumonia [12] . His death prompted his nephew, Dr. C Anandakumar to relinquish leadership of the GIC to Assoc. Prof. Arunachalam Ilancheran and to leave for private practice. Anandakumar subsequently to head SSR International Private Limited at Camden Medical Centre , an O&G centre of excellence named after his late uncle.

Final closure [ ]

The Gender Identity Clinic at the National University Hospital drew its shutters for good in 2008. When asked by The Straits Times in 2014 about the Ministry of Health 's stance on sex-change surgery, its role in overseeing the procedure, and why public hospitals had stopped offering it, an MOH spokesman would only say that "sex reassignment operations are not subsidised and are performed with...safeguards".

Demand, however, had not shrunk, according to private psychiatrist Prof Tsoi Wing Foo . Since 1971, Tsoi had seen over 2,000 transgender patients, half of whom went for surgery. A psychological assessment is needed before sex reassignment surgery can be carried out on a patient in Singapore. During the 1970s and 1980s, he had roughly 30 cases a year. From 2007 to 2014, he had seen an average of 40. He did not know why surgery options here were dwindling, but speculated that it could be due to public policy changes or the personal preferences of the few doctors who had undertaken such surgery. Dr C Anandakumar , who was the gynaecologist in charge of the GIC until 2001, declined to speak to press when queried.

Despite the fact that many male-to-female transgender patients were flocking to Thailand for their surgeries because of the lower cost and less stringent psychological requirements, female-to-male transsexuals were still seeking help from the GIC. Such operations are more complex and cost SGD $15,000 or more here. But psychiatrist Prof Tsoi Wing Foo believed that many female transsexuals would head to Bangkok as well once the operation was available there.

Dwindling cases of sex reassignment surgery in Singapore [ ]

A 28 December 2014 article in The Sunday Times by Hoe Pei Shan ([email protected]) revealed that sex change operations were dwindling in Singapore [13] .

In the 1970s, Singapore had become a global destination for sex change surgery , with public hospitals dealing with hundreds of cases every year. Such operations in public hospitals ceased since 2013, forcing transgender people wanting sex reassignment surgery to look to Thailand and South Korea . The National University Hospital ( NUH ), believed to be the last public hospital to perform sex change surgery , said it no longer offered the procedure. It did not give a reason, and the Ministry of Health ( MOH ) also did not reply specifically when asked about the issue.

The only known surgeon still performing sex change surgery in private practice - Dr Colin Song of Cape Clinic ( Cape Plastic Surgery Pte Ltd ) which opened in the middle of 2013 - said that "one known concern" surrounding sex change had been the spread of HIV . The authorities had asked hospitals to phase out sex change surgery in the late 1980s for fear that hospital staff might be exposed to the virus. MOH did not considered sex change surgery as a life-saving procedure. The objection was lifted in 2001.

When asked about the ministry's current stance on sex-change surgery, its role in overseeing the procedure, and why public hospitals had stopped offering it, an MOH spokesman would only say that sex reassignment operations were not subsidised and were performed with... safeguards. Demand, however, had not shrunk, according to private psychiatrist Tsoi Wing Foo , who co-wrote a book on transsexualism here with Singapore's pioneer sex-change surgeon, the late Dr S Shan Ratnam .

Since 1971, Dr Tsoi had seen over 2,000 transgender patients, half of whom went for surgery. A psychological assessment was needed before sexual reassignment. During the 1970s and 1980s, he had roughly 30 cases a year. From 2007 to 2014, he had seen an average of 40. He did not know why surgery options here were dwindling but speculated that it could be due to public policy changes or the personal preferences of the few doctors who had taken on such surgery. Dr C Anandakumar , who had worked with his uncle, Prof Ratnam, declined to speak to The Sunday Times .

Prof Colin Song of Cape Clinic specialised in female-to-male operations and had previously worked at Singapore General Hospital . A male-to- female operation at Cape cost $55,000, with the reverse being slightly more expensive, said Prof Song. While NUH declined to reveal its most recent rates, such operations used to cost between $8,000 and $15,000 in 2018.

Prof Song said he had yet to see a patient for full reconstruction since setting up Cape . Most sought partial reconstruction, such as removing breast tissue, as it changed the outward appearance and is more economical. The adjunct professor at the Duke-NUS Medical School , who had been performing sex change surgery since the early 1990s, said high facility costs were the main reason he could not match the rates public hospitals used to offer. 8 in 10 patients whom Dr Tsoi had referred to him for surgery chose to go to Thailand , "mainly because of costs". In Thailand , a full sex change cost around $20,000 in 2014.

Those who went overseas for surgery might have to do without the immediate support of family and friends right after surgery, while cultural and language differences might affect the quality of post-operative care, said Oogachaga Counselling and Support deputy director Leow Yangfa . Oogachaga provided support for the LGBT community .

Transman activist Joe Wong , who underwent a gender affirming operation in Bangkok , said doctors there were "only concerned about performing the surgery and provided little or no information on post- operative care and follow- up". The then 30-year-old said he knew the risks in having surgery overseas, but with scarce options in Singapore, he had little choice.

See also [ ]

• Sex reassignment surgery
• Transgender people in Singapore
• S Shan Ratnam
• Arunachalam Ilancheran
• C Anandakumar
• Tsoi Wing Foo
• Gender Identity Clinic
• Archive of "'Help sex-change patients to a normal life' plea", The Straits Times, 25 November 1973

References [ ]

• Chan Meng Choo, "First sex change surgery (1971)", Singapore Infopedia [14] .
• Ho Pei Shan, "Sex change operations dwindling in Singapore", The Straits Times, 30 December 2014 [15] , [16] .
• Rachel Chan, "Bet you didn’t know that Singapore used to be a hub for sex change ops", The Popping Post, 16 January 2016 [17] , [18] .
• Chua, M. (1974, November 7). Who really needs a sex-change?. The Straits Times, p. 10.
• Cheow, X. Y. & Fung, E. (2007, March 7). Born in the wrong body. The Straits Times, p. 114.
• Fifth sex-change operation a success. (1972, September 11). The Straits Times, p. 6.
• Kwee, M. (1974, October 20). S’pore’s first sex change woman. The Straits Times, p. 1.
• Lim, S. (1990, May 20). Legal poser over sex-change transsexuals who get hitched. The Straits Times, p. 21.
• Ratnam, S. S., Goh, V. H. H., & Tsoi, W. F. (Eds.). (1991). Cries from Within: Transsexualism, Gender Confusion & Sex Change. Singapore: Longman Singapore. (Call no.: RSING 616.8583 RAT)
• Second sex change operation in S’pore. (1971, November 5). The Straits Times, p. 15.
• Sex change man signs statutory declaration affirming that he is now a woman. (1972, April 16). The Straits Times, p. 6.
• Tan, K. H., & Tay, E. H. (Eds.). (2003). The History of Obstetrics and Gynaecology in Singapore. Singapore: Obstetrical & Gynaecological Society of Singapore: National Heritage Board. (Call no.: RSING q618.095957 HIS)
• Tan, W. L. (1971, August 25). Sex change patient has marriage plans. The Straits Times, p. 8.
• Tan, W. L. (1971, August 31). Man-made woman may not get marriage licence. The Straits Times, p. 6.
• Tan, W. L. (1971, November 11). They’re still ‘misters’ despite sex change. The Straits Times, p. 8.
• Why sex-change patients set up homes overseas. (1975, August 10). The Straits Times, p. 5.
• Yeo, J. (1971, July 31). First sex change surgery in S’pore. The Straits Times, p. 17.
• Jeffrey Hays, "Homosexuality, gay life, and sex change surgery in Singapore", Facts and Details, 2008, updated June 015 [19] .

Acknowlegdements [ ]

This article was written by Roy Tan .

• 1 Blowing Wind
• 2 Singapore gay saunas
• 3 Shogun (Singapore gay sauna)

State health plans must cover gender-affirming surgery, US appeals court rules

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Advocates: Ban on reassignment surgery for minors would have broad impact on NH health care

Apr. 26—CONCORD — Alice Wade, a transgender woman from Dover in her 20s, said she had to go to Washington to have gender reassignment surgery last summer, and the follow-up services she received at a local hospital here were "laughable."

Wade and many transgender activists said that passing legislation to ban these procedures for anyone under 18 would harm the entire LGBTQ+ community.

"New Hampshire needs to improve when it comes to trans health care, and bills like this will make it harder," Wade testified during a hearing last week on the House-passed ban HB 619.

State Rep. Erica Layon, R-Derry, said the prohibition is appropriate because of the risks and experimental nature of the surgeries, especially on young people.

Layon noted state law does not allow a minor to use a tanning bed until they turn 18.

"I want people to be their authentic selves, but minors having this surgery is a disservice to parents and to minors," Layon said.

If the bill becomes law, New Hampshire would join 23 states that outlaw gender reassignment surgery for minors.

Transgender people like Wade have left the state to get the surgery where it was legal and available.

A coalition of health care organizations also spoke out against the legislation, which would contain the first provision in New Hampshire law to block physicians from making a medical referral, presumably in this case to an out-of-state provider who could perform the surgery.

Those organizations included the New Hampshire Hospital Association, National Alliance for Mental Illness, NAMI New Hampshire, the New Hampshire Medical Society and New Futures, a public health advocacy group.

Dr. Keith Loud, director of the Children's Hospital at Dartmouth-Hitchcock, said it's already hard to attract medical professionals to perform specialized procedures even without such proposed laws.

"Bills like this have a chilling effect on the ability to recruit and retain highly skilled individuals," Loud told the Senate Judiciary Committee.

Sen. Becky Whitley, D-Hopkinton, a candidate for Congress, said she found the ban on referrals the most troubling.

"Why in this one case are we legislating the practice of medicine?" Whitley asked Layon at one point.

Layon said the state has created guardrails for some medical practices, including a ban on conversion therapy for gay people.

Chris Erchull, a lawyer with GLBTQ Legal Advocates & Defenders (GLAD) said a report from the Journal of the American Medical Association found from 2016-2021 there were 101 gender reassignment surgeries for minors under 18 in the U.S., about 20 a year.

Often this was a vaginoplasty for a 17-year-old trans person so the surgery and recovery was complete before the minor headed off to college, Erchull said.

"This targets a class of people and denies them access to treatment," he said. "It is unconstitutional to single out a group of people for treatment under the law."

Under the bill, minors could still have surgeries if needed to correct a "malformation, malignancy, injury or physical disease." Surgery would also be permitted for sex development disorders or circumcision of males.

The House passed the bill last January, 199-175. The vote was not along party lines.

House Republicans backed it, 186-2.

Rep. Dan Hynes, a Bedford Republican who changed to independent before later resigning from the House, also voted against the bill.

House Democrats opposed it, 172-11.

[email protected]

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