As the issue of Gender Dysphoria continues to pop up in global headlines, Mona Daoud speaks to Egyptian lawyers, doctors and transgender people about the trials and tribulations of being accepted for who you feel you are.
Transgender people don’t have the luxury of choice you might mistakenly think they have. Although the medical community, on an international level, is at war with itself, unable to settle on whether Gender Dysphoria (identifying with a gender other than the one assigned at birth) is a medical condition or not, one thing is clear; it is not a choice and can only be treated by accommodating it.
A transgender person does not wake up one morning and decide ‘oh I want to be the opposite sex’. Transgender people feel, from as early as 4-years old, if not earlier, that they are “stuck in a foreign body that does not belong to them,” says Dalia Abdel Hamid, Gender Officer at EIPR (Egyptian Initiative for Personal Rights). The sex they are assigned at birth is at severe conflict with their perception of their own gender identity. There is absolutely nothing that can be done about it, except to help them adapt their bodies to their perceived gender. This has nothing to do with being progressive, it is a scientific fact.
All mental conditions that transgender people have to deal with have very little to do with the gender perception, and assigned sex at birth conflict, and everything to do with how communities and societies react to them. This ranges from bullying in schools, to being ostracised and rejected by family members and loved ones, to being subjected to constant ridicule, human rights violations, and the inability to simply exist.
It is a grim and lonely life for many all over the world. Can you imagine what it’s like in Egypt?
The Unexpected Governmental Stand
Surprisingly, the Egyptian government acknowledges transgender people now. Although in 2003 a bill was passed allowing Sex Reassignment Surgeries only to people who were born as both sexes, known as intersex, this was amended in 2013. The Egyptian Medical Syndicate issued a new Code of Ethics that allows anyone diagnosed with Gender Identity Disorder to get their surgeries for free at Kasr El Einy hospital, provided they completed two years of real life experience in their perceived gender and followed up with a psychiatrist. After the surgeries, and with a paper stamped by a government hospital, they can then go to change their National Identification Card information.
Sadly, this is all theoretical, as are most Egyptian laws. There is strong resistance from individuals working for the government to grant transgender people their lawful rights. At the top of this list is El Azhar employees, who are required to be present on the panel that issues the permit for Sex Reassignment Surgeries. Currently, the assigned El Azhar employee is refusing to be on the panel, rendering it inactive. Medical officials are currently trying to motion for the panel to proceed without El Azhar, who have failed their very own employees and students who have undergone the surgery, by refusing to reinstate them in their positions, or allow them to continue their education.
To make things worse, even if a transgender person changed their ID and passport, they are not allowed to change the gender or name on their graduation certificates, which then presents a major problem when looking for a job.
There is a major misconception that transgender people are liberal people who just won’t conform to society. The reality is a transgender person can be anyone. They can be very strict Muslims or Christians, or they can be moderate, conservative or liberal. And no, they are not gay by default. Sexual orientation has nothing to do with gender identity. In fact, many Egyptian transgender people are ridiculously homophobic like the rest of the population, and resent being classified as gay.
Transgender Haven? El Hussein University Hospital Psychiatric Department
Another surprise is that the best place for a transgender person to go is the amazingly progressive psychiatric department of El Hussein University Hospital. The department does not try to ‘cure’ patients of Gender Dysphoria. They help them deal with the psychological issues they have as a result of being ostracised, or the conflict within themselves, as often they are unable to accept themselves and think there is something wrong with them. The department helps them with the long journey that starts with therapy to deal with the traumas they suffered and helps ease them into the transition phase which ranges between dressing as their perceived gender, to taking hormonal treatment under medical supervision, to surgery and further therapy helping them live as the gender they identify with.
The department offers one-on-one therapy, group sessions, and is generally a community for transgender people to talk, meet, and get the help thy desperately need. It comes as no shock that the rest of the hospital ridicule the department and make life difficult for them, going so far as trying to shut them down.
In spite of the government acknowledging transgender rights all the way from the law, to the governmental medical community, to allowing transgender people who have undergone Sex Reassignment Surgery to marry and even adopt, they are continuously arrested and harassed by the very government that is supposed to be protecting them by law.
Charges range from debauchery to prostitution, and although many transgender women resort to prostitution since they are literally unable to find any other job under the sun, most charges are framed by ‘law enforcers’ who are simply prejudiced. Needless to say, once arrested, transgender people are subjected to beatings, rape, mockery, and long, illegal prison sentences.
Real Life Experience
Bassem, a transgender man who has a permit from the panel to undergo surgery, says that "unless a transgender person is psychologically treated by at least 60%, they end up committing suicide." Bassem is one of the lucky ones. Although he does not have his family’s approval, and had to leave the governorate where he grew up, he considers himself privileged to have found support at El Hussein University Hospital, and gotten a permit before the panel was rendered obsolete. He is in touch with his family who still talk to him in spite of their disapproval. He found relief ever since he started taking hormones to lower his voice and promote the growth of facial hair, and undergoing breast removal surgery as the first surgery of many to come.
He tries to focus on the positive and ignore the negative. For example, he remembers the nurses from the hospital very fondly, as they were very supportive and kind to him. Meanwhile he ignores things like the extorting private surgeon who did the surgery, and refused to remove the stitches unless Bassem coughed up an extra 150 LE, even though he had paid for the surgery in full, and the removal of stitches are thus supposedly free of charge. That surgeon goes so far as to charge patients extra if they don’t have a permit from the panel. Pure extortion. And he is only one of many.
Bassem is currently living off of his father’s pension and is unable to find a job because of his ID that lists him as a woman. He is unable to go back to school to study psychology which is his dream. However, he spends his time writing, and hopes to be a published author and a transgender activist one day. Only 24-years old, he has his whole life ahead of him and he is being optimistic.
“I tried to be a girl but it only made things worse. My advice to any transgender person is to not let themselves go. Seek help,” says Bassem.
Trying to Help
There are many transgender friendly psychiatrists and surgeons, governmental and private. Leading names include Said Abdel Azim and his daughter Radwa Said Abdel Azim, Ahmed Okasaha and, last but most certainly not least, Hashem Bahary. There are many others of course, but these are the leading names who specialise in transgender patients understanding all their needs.
Being transgender is not an illness, and it is not a social deviance. It is a condition that can only be treated by self acceptance and living in one’s perceived gender, whether they are just satisfied with dressing according to the gender identity, or taking hormones, or going the whole way and having surgeries, which many are not necessarily interested in. Many are afraid to undergo surgery, especially here in Egypt where it is relatively new.
A judge in Alexandria was so ignorant as to demand a test of chromosomes before ruling in favour of a transgender woman who was suing for her rights. Gender Identity and Gender Dysphoria, can only be determined by a psychiatric report, and the law is very clear on that. No chromosome tests, or hormone tests or any other test under the sun can determine gender identity.
“We tried to build a database of transgender friendly doctors, but we failed,” says Abdel Hamid. "We tried helping transgender people with their papers, but it is almost impossible, given the social stigma. It is almost a dead end depressing situation.”
The lucky ones are the survivors who fight and come out and seek help, and even then, they are not free from alienation, physical and psychological harassment, and depression. The rest live in a dark world trying to self-medicate.