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Published on April 4, 2008

On April 1, the Medical Council issued a ban on all such operations, pending further deliberation. This article is not intended to support or oppose the ban, but to draw attention to the context that young Thai male-to-female transgenders live in.

Testicle removal has been a social phenomenon among Thai katoeys (transsexuals) for a number of years. The reason for last week's uproar was only because of its occurrence among youths, who are regarded in Thai society as being impressionable, vulnerable and easily led astray by fashions and trends. Many youths may misunderstand the situation and see "transgenderism" as a fad. But the irreversible procedure may later become nothing but a grave mistake.

This whole scenario follows an established routine. Thai society preaches to its younger members that they must obey rather than think and make rational decisions. This is also the case regarding drugs, teenage pregnancy or STDs and Aids. When problems arise, adults immediately point the finger of blame while ignoring the responsibility to educate and inform future generations that they can be responsible for their own life decisions.

Although some people are of the opinion that transgenderism is a mental disorder to be treated by hormone and surgical therapies, that definition, in my opinion, would also define mental illness in anyone who is unsatisfied with their body make-up and who takes supplementary vitamins or seeks surgical procedures to modify the way they look.

The wish to undergo castration among young boys is no different from the desire for good looks among their peers of both sexes. The pressure to look beautiful is imposed equally on everyone by an adult-controlled media. Witness all the slimming and fitness centres and clinics offering nose jobs and eye-lid operations, all catering to young people.

Deciding to go under the surgeon's knife, and especially for castration, is indeed exercising the right to control one's own body. However, the young would-be patient should be fully informed of the short- and long-term consequences of this irreversible operation, as well as the alternative options.

Such information must go far beyond medical facts, because the young patients will eventually have to leave the hospital bed and rejoin society. So it's important to bring in contextual-based knowledge about the reality of life as a katoey, the effects of hormone therapy - which they will have to take for the rest of their lives - and sex reassignment surgery, if desired. Their decisions - or co-decisions with parents, in the case of underage patients - based on fully informed consideration, should then be respected by society.

Having said that, there are very few studies concerning the life of Thailand's transgenders. Among the few that exist, some were based on transphobic prejudices. Largely neglected by the medical establishment, these people are left with little choice but to use their own bodies as guinea pigs for hormone and surgical therapies. Results - reliable or not - are taken as proof and become precious information that is shared, peer-to-peer, by word of mouth.

If in the end the Medical Council decides to ban testicle removal, underground clinics will most certainly spring up to meet the demand for the operation. Like illegal abortion clinics, the existence of these substandard outlets will result in major public health problems.

More than the ban, what is urgently needed is the government's support for more research on transgender health in order to create relevant knowledge to help people make safe and rational decisions. Just like a woman with breast augmentation gone awry, or a man with a disastrous penile enlargement procedure, a transgender often falls victim to commercially-geared medical services that respond more to profit than health and safety.

For a healthier society, Thais would do well to look less at the mirror and learn to see deeper than the skin. We should also get used to the idea of human diversity in all shapes and forms. While the majority may choose to live their lives based on their genitalia at birth, being a transgender is an equally valid life decision as a human being.

jetsada taesombat is programme assistant at the Southeast Asian Consortium on Gender, Sexuality and Health, at the Centre for Health Policy Studies, Mahidol University. Self-identified as a male-to-female transgender, Jetsada's work involves the integration of gender and sexuality perspectives into public health policies; programme intervention; and advocacy. 

Jetsada Taesombat

The Nation