With recent discussions about psychological disorders, intersex and deviant behavior, Egyptians are not aware of the phenomenon of so-called sex reassignment surgery or Gender Identity Disorder (GID), the distress a person experiences with the gender they were born with.
There are those who accuse people experiencing these phenomena of simply being “perverts,” but the situation is in fact completely different. While the “pervert” does not resort to sex change operations, those who do are people born with an imbalance due to a hormonal disorder in the brain which afflicts the child before birth. With regards to intersex persons, these children are born with clear congenital defects, in which there is a reconciliation between the mind and the body, which makes an operation easy to perform.
Doctors assert that GID persons have the right to undergo transgender operations but the government refuses to legalize them. The phenomenon is also surrounded by social stigma and Egypt’s al-Azhar, the Sunni Muslim world’s most prominent religious institution, does not grant approval for patients to undergo these operations.
In a series of forthcoming articles published over separate days, Al-Masry Al-Youm, the sister Arabic-language publication of Egypt Independent, opens up the gender identity disorder subject to delve deep into the psychological suffering transponders usually go through, social rejection, medical perspective and Islam’s stance on gender identity.
Sexual disease consultant: GID is a brain disorder
Consultant of urology and venereology at the Kasr Al-Aini hospital and the Nasser Institute Mohamed Abdel Rasoul said that Gender Identity Disorder is believed to be a psychiatric illness. However, after scientific studies, it was discovered that it is a brain defect caused by an intrauterine problem or hormonal disorders to which the fetus is subjected before birth.
Rasoul explained that this appears in the child after birth, when it reaches the age of three. The child’s behavior changes and it feels that it is the opposite sex, and behaves like it in various aspects of life, from the style of playing to the way to use the toilet. The mother may try to change those habits, but she usually fails because they are fixed in the child’s brain.
“The period of adolescence is the most difficult period a GID patient experiences in his life because his mind completely rejects his body. As for the surgery, the issue is different, meaning that the surgeon does not intervene in the system of diagnosis and determining the type of treatment,” Rasoul said.
He explained that “the only body entrusted with the decision of the surgery is a special committee [the Gender Reassignment Committee] on the disease that began its work in 2009 […] but stopped 4 years ago [in 2013],” he said.
“The committee was composed of the committee chairman, two psychiatrists, a professor of andrology, a professor of genetics from the National Research Center, and a Sheikh from Dar Al-Iftaa.”
He went on to say that “the committee was studying each case carefully and examined the tests of hormones and radiation images, and the psychological report and everything related to the case. If the committee approved the validity of all these papers, then the approval for the surgery should be by consensus, and the decision is made and approved by the committee, after which comes the role of the surgeon,” Rasoul said.
“In the first period, we were approving the surgery only for intersex and not GID patients, including every patient who has a clear problem, whether hormonal or organic. For example, a patient with a penis but with female genitalia inside, such cases has no problems in [getting approval] for surgery and the procedure is successful, after which the patient lives a normal life,” he explained.
Both intersex and GID cases were introduced to the Egyptian Medical Syndicate between 2009 and 2013, Rasould went on, adding that “the procedures were being performed on intersex cases, and were successful at a very large rate, which encouraged GID patients.”
He also noted that it was cheaper to do it in Egypt than for example in Thailand, which was, according to Rasoul, “almost the only country competent to conduct that type of surgery at the time.”
“The most difficult decision to be taken by the patient is the decision of the surgery because it is very complex, and is conducted from three to four .
Psychologists and sociologists: beware of misconduct in education and parenting
Psychologists and sociologists Al-Masry Al-Youm spoke with warned against misconduct in the method of parenting and education during childhood so as not to make one’s children be struck by GID. If parents do not beware, they will be forced to make their children undergo surgery or risk that they commit suicide when they grow older.
Professor of Psychiatry at Al-Azhar University Hashim Bahari said that the disease has no clear cause. It is a change in the brain or social changes due to parenting, such as misconduct in parents’ education.
He explained that there are some families that prefer to have a boy, which make them treat their daughter like a boy. She may be raised like a boy completely.
Bahari said that the deterioration of relations between parents or divorce may affect the child’s psyche and make them deny his oppressed gender, whether male or female.
“The real problem of patients with GID lies in the brain only. He has a male body but with the mind and feelings of a female, and vice versa. The patient is not considered a pervert, as seen by some, but is suffering from a sexual disorder, meaning that he defines himself as belonging to the other sex, and therefore the male is attracted to the same gender and vice versa, which makes some interpret it as a pervert case,” Bahari said.
“The society meets this with denial based on its customs and traditions, and even the rejection of these patients, who continue [to suffer from] their illness for many years, and undergo treatment, which leads them over time to depression, especially with the failure of psychological treatment, and may end with suicide,” he added.
Bahari stressed that GID patients often suffer psychologically since birth and through a sad childhood and the inability to play with children of the same sex. In adolescence they may suffer depression and wish to commit suicide because it is the only solution to escape.
He pointed out that the role of the psychiatrist is to organize a program of treatment and subject the patients to it for two years. Two situations would come out of this; to convince them to accept that they are in fact not GID patients and does not need this transformation, and, if this fails, the patients can choose to undergo surgery, especially after being partially removed from all the surrounding effects.
Bahari explained that the program is divided into two stages, each of which is a full year long. During the first, the patients will be accustomed to dealing with the community in their sex assigned at birth, and in the second stage, the patients will be treated as the opposite sex that they wish to switch to.
Then the doctor decides whether or not the patient needs the surgery. The role of psychiatry does not stop at the pre-surgery stage, but extends beyond the completion of the surgery and the patient’s transformation and after, Bahari said.
He added that the surgical procedure brings out the patient with a new status and a new gender for the community to deal with, and sometimes the patient exaggerates his new role to attract attention.
Bahari stressed that despite all of this, transgender persons are faced with societal rejection even in societies that accept this type of surgeries. The patients thus enter into a spiral of psychological and social troubles, as well as the deformity in a part of their body, and find themselves unable to adapt to their new situation.
On her part, sociology professor Thuraya Abdel Jawad said that GID patients in Egyptian society suffer from severe restrictions, particularly since Arab culture has two different concepts for masculinity and femininity and how to deal with each.
Jawad explained that the attitude towards women in Arab societies is always linked to pornography and shame, while masculinity is linked to role models and wellness. Therefore, when Arab society describes a woman with good manner, it says that she is “equal to one hundred men”.
“Whenever there is cultural and social awareness, the more they are considered patients with hormonal dysfunction, the more society views them as natural. But with poverty, ignorance and lack of education, with a degrading view of women and biased view of masculinity, then the society rejects this illness,” she said.
“But in the developed societies, the decision of the procedure is the patient’s own, and it is not easy for the person to take such decisions and s/he is allowed to undergo the operation easily because they have a strong awareness. But here our religious culture which is entrenched in our Arab societies prohibits any change to God’s creation,” Jawad said.
She also pointed out that one of the great paradoxes in Arab societies is that if a woman transformed to a man, he does not face opposition from society, which is contrary to what often happens when a man turns into a woman.
This was reflected in the film El-Sada El-Regal (Gentlemen), Jawad said. When the heroine changed her sex, her mother received the news with rejoice, while the opposite happened when a man changed his sex. This is because women bring shame, Jawad noted.
“The perception of those patients is related to the culture of society, the degree of religiosity, education, and the complexity of the perception of sex. Our society [rejects] the transgender procedure completely and I remember a medicine student who turned into a female and his faculty has not recognized her so far,” she explained.
“In our society, most problems are centered around sex, and all this causes patients with GID to have a negative societal culture with rejection and non-acceptance from the family and society,” she said.