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Moving between the sexes By Ruth Sinai Tags: Health Ministry, transgenders  Ever since he can remember, he has felt like a boy and felt like a stranger in the girl's body he was born into. At the age of 16 he decided to change his body. Years went by, during which he gathered information about the process and met people who had been through it. "At first I was terribly afraid of the surgery," he relates. "I spent a long time wavering, but the more I heard and the more I spoke to people, the fear left me." When he felt ready, he applied to the committee for the approval of sex change operations that convenes at Sheba Medical Center, Tel Hashomer. "They said that I had to go through examinations and wait for two years for the surgery," relates the young man, who is not prepared to have his identity revealed. Not out of embarrassment, he explains, rather for fear that this might harm his chances of getting the committee's approval. "I thought I would come and immediately start hormones, but it doesn't work that way. Just to make the first appointment with the psychologist took several months. After the appointment she refered me to an endocrinologist, and until I got an appointment it took several more months. I couldn't wait and in the end I went to a private endocrinologist and paid NIS 770," he relates. Advertisement The committee operates in accordance with a Health Ministry procedure that was written in 1986, after a sex change operation nearly caused a patient's death. Under the procedure, a person who wants to undergo surgery of this sort has to receive approval from all five members of the committee - an endocrinologist, a urologist or gynecologist, a senior plastic surgeon, a psychiatrist and a psychologist - and to live for at least two years in the desired gender identity. The regulations also prohibit carrying out the operation privately, and permits it to be performed only at Sheba. In response to a request from the Physicians for Human Rights organization, the Health Ministry has established a committee to re-examine the procedure. Last week, the committee held its first meeting, at which the participants presented their views on the matter. There are already signs of opposition from some of those involved to the demand to make the criteria more flexible. The second meeting will be held next month. "Since the procedure was written, fundamental changes have taken place in social perceptions and today there is awareness that people don't fit into the traditional definitions of sex, sexuality and gender, and there is increasing recognition of their right to protection from violation of their basic rights," wrote attorney Dr. Yuval Livnat to the head of the Medical Administration at the Health Ministry, Dr. Hezi Levy. Levy has not only accepted this argument and set up a committee to examine the procedure, he also agreed with Livnat that the voice of the transgenders should be heard, and appointed to the committee Nora Grinberg, who had her surgery abroad in order to bypass the procedure and the committee in Israel. "I was 50 years old, married with two children and I figured that I didn't stand a chance that they would approve the surgery for me," she says. "I knew that the procedure here is very conservative, and I also couldn't wait for two years. I was in deep distress and thought either I get the surgery or I jump off the roof. The decision to travel to London saved my life," she says. It is difficult to obtain precise figures as to the number of applicants to the committee, the number of approvals and rejections, and the number of people who have undergone the surgery. According to information that came into Livnat's possession recently, the committee said that there are 12 operations a year, but Grinberg and others say that over the years they have heard different numbers from committee members. There is agreement about one thing: The number of applicants and operations are rising. According to international epidemiological data, one out of every 30,000 men and one out of every 100,000 women feel unsuited to their gender. In the Netherlands, they say that these figures are outdated and that today the phenomenon is more common: one out of 12,000 men and 30,000 women. Grinberg says that about 10,000 sex change operations are performed annually worldwide, and another unknown number in China. She has no doubt that demand has increased, and finds support for this view in the fact that since she had her surgery in 2001, the price in Europe has more than doubled. Thailand is the preferred international destination. In special clinics there it is possible to have various kinds of surgery and recover for a month afterward. The price ranges from $8,000 for constructing a vagina to $15,000 if breast construction and lip and cheek sculpting are added. Dr. Ilana Berger, a social worker who is a clinician in the area of sexuality and gender and moderates support groups for transsexuals, says that more than 80 percent of her patients have the surgery abroad. "At Tel Hashomer they work in an old-fashioned way," says Berger. "The most difficult problem is with patients who have been living in their new gender for a long time and are required to wait for another two years. This is torture." According to the procedure, a candidate for sex change must fit certain criteria that define him as a transsexual. "The Health Ministry should not be engaged in defining and cataloging people," Livnat wrote to Levy. "The important question is whether there is any reason to prevent an adult individual from choosing how to live his life." The requirement to undergo the surgery at a public hospital gives off "a bad smell of government supervision of gender and sexuality of men and women in society," wrote Livnat. The need for the committee's approval is also not clear in light of the fact that approval for other kinds of plastic surgery does not require the convening of a committee, he added. Livnat believes that the requirement for a diagnosis by a psychologist and a psychiatrist has its origin in the view that a person who wishes to change his gender identity is suspected of being mentally ill. In other countries, sex change operations do not require the approval of a committee, although usually the candidate for surgery is required to produce a psychological opinion from two experts who have examined the individual's readiness and mental suitability for the process. Canada requires a person who wants a publicly-funded sex change operation to be interviewed, fill in a questionnaire that includes 100 items, and obtain opinions from two psychiatrists, says Berger. However Canada, like most countries, does not condition the surgery on a two-year wait during which the candidate must live in the new gender identity he or she wishes to adopt. According to the recommendations of the Harry Benjamin International Gender Dysphoria Association - an international professional organization for the treatment of people who wish to change their gender identity - a person who wants a sex change operation should experience the new identity for a consecutive year in order to make certain that he is ready. Grinberg dismisses the need for supervision of the sort that exists in Israel. "At the committee at Tel Hashomer they say that the supervision is needed because this is a procedure from which there is no return. There are lots of operations from which there is no return," she notes. "The responsibility is the individual's - he is the one who feels that his body is not his own. The rate of suicide attempts among transgenders is higher than in the general population. The surgery can save lives. All that is needed is to examine whether the individual is capable of making a considered decision." Most transgenders do not undergo sex change operations. About half the males who want to become women complete the process with an operation, but only a minority of females who become men undergo surgery, in part because constructing a penis is complicated, requires many stages and is expensive. Many men also don't think they need a male sexual organ to complete the process, whereas women feel that they need a vagina in order to complete the gender experience," says Berger. Berger relates that when she began treating transgenders in Israel in 1997, nearly all her patients were women who had been born as men. During the past two years the ratio has reversed, and today only 20 percent of participants in the support groups that she moderates used to be men. She has no doubt that if the new committee makes the criteria more flexible and allows private operations in Israel, the number of operations will increase and expertise will develop in the field - which might even attract transgenders from other countries to Israel and constitute competition to Thailand. Bookmark to del.icio.us   Beatle terror Islamic militant leader threatens to kill former Beatle, Sir Paul McCartney, over Israel gig. Fugee Fridays Every Friday, volunteers bring donated food from Carmel Market to African refugees.

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