Mercedes Allen

The Facts About India's Infant 'Sex Changes'

Filed By Mercedes Allen | July 22, 2011 5:00 PM | comments

Filed in: Living, Marriage Equality, Transgender & Intersex
Tags: David Reimer, India, intersex

indiasurgassign.jpgCanadian and international press outlets reported last month that in India, the preference to have male children is so strong that parents are having their female infants surgically assigned (a.k.a. "sex changes") to male. There were all sorts of problems with this story, but some of the verdicts have come in. Here are the facts (to the best of our available information) of the matter.

First, an early headline:

In a stunning revelation reported in The Telegraph Monday, parents in India are allegedly paying £2,000 (around $3200) to have their young daughters undergo gender reassignment surgery in order to turn them into sons -- all in the hopes of dodging the added expense of raising a girl. Indian culture favors males for their income earning potential and due to the fact that unlike females, they won't cost their families unnecessary educational expenses and wedding dowries.

Currently, there are 7 million more boys than girls under age six in India and there's clearly a reason for that. In a country where female foeticide (gender-based abortions) are commonplace, this new twist has many fearing children aren't safe even after they are born. Madhya Pradesh state government is already investigating 300 cases in which girls have reportedly undergone genitoplasty.

Information on this story was awful, with reports contradicting each other and no definitive picture of what is actually happening. Reporting had sometimes used shock phrasing like "Girls as young as one are being forced into sex change operations...."

Some news sources in India had been clarifying that the infants being surgically assigned to male are intersex, which is still bad (and I'll explain why shortly). "Intersex" covers a wide range of medical conditions in which a child is born with genetic, gonadal and/or morphological traits that don't exactly match the ways we define "male" or "female." The medical establishment sometimes uses the term "Disorders of Sex Development," but intersex advocates almost overwhelmingly find that terminology stigmatizing and offensive. Some intersex conditions aren't immediately obvious (such as Klinefelter's Syndrome) and a person might go entirely through life without knowing that they have such a condition. Others have more physically visible traits, which clinicians often feel is their duty to "correct."

While some media outlets have been reporting the intersex connection, others have been leaving the impression that it is a widespread problem resulting in surgery for any infant, intersex or cissexual. The Telegraph article being referenced attempts to resolve this by stating that some parents are coercing or bribing doctors to misidentify newborns as intersex, so that surgery can be performed - though they don't indicate a source for this information.

This inevitably spun off some far-right media rhetoric, using the idea of sex-selective infant "sex changes" to validate their campaigns against abortion in China and India (and by extension, all abortion), since it's a grey area they can win support with. It's worth noting, though that some pro-choice organizations like the Center for Genetics and Society have also spoken out against sex-selective practices, commenting that even the U.S. has seen a rise in preimplantation genetic diagnosis (PGD) and sperm sorting used to select the sex of a child:

Sex selection raises concerns about exacerbating sex discrimination and violence against women, and normalizing the "selection" and "design" of children. The use and marketing of sex selection technologies are largely unregulated in the United States. Although the ongoing attacks on abortion rights complicate efforts to address even pre-pregnancy methods, a number of countries--including Canada, Germany, and the United Kingdom--prohibit "social" sex selection without affecting abortion rights.

Disparity in Value

The most apparent issue that mainstream media has taken from this story is the glaring difference in value that Indian society (as with many other parts of the world) places on males, as opposed to females. It's certainly likely that disparity in gender valuation factors into parents' decisions when surgical assignation of gender occurs in China and elsewhere (even here). And if the practice is being abused in India, it's certainly conceivable that it's being similarly abused elsewhere. Ms. Magazine comments on the harms caused by sex-selective practices:

Its consequences are anything but abstract in the regions of South and East Asia where the wildly skewed sex ratio among the generation now coming of age is associated with an upsurge in trafficking of women for sex and for marriage-to the extent that some poor villages are empty of young women. And some of the most alarming sex ratios are in affluent areas; economic and technological developments are in fact driving sex selection rather than discouraging it by encouraging smaller families, which leads people who value sons to do whatever is required to ensure one.

India is facing a significant disparity between male births and female births, having become one of the nations considered notorious for sex-selective abortion (perhaps even second to China). The Telegraph quotes a figure of 866 girls being born for every 1000 boys in India, from the Centre for Social Research's Ranjana Kumari, who adds:

"People don't want to share their property or invest in girls' education or pay dowries. It's the greedy middle classes running after money. It is just so shocking and an outright violation of children's rights."

The government needed to address the problem by stressing the spiritual value a girl or woman brought a household in Hindu culture. "In India we say God resides in that house where there's a woman but that has evaporated because of all this greed. We need to emphasise the spiritual wealth a girl brings to a family, but we also need to support them with financial subsidies and jobs," she added.

In the article that first broke the story, The Hindustan Times, claims that these surgical assignments have been happening "by the hundreds," and to children who are up to 5 years old:

About seven paediatric surgeons from Indore - who are associated with top private and government hospitals - perform these surgeries...

Another Indore paediatric surgeon performing this procedure, Dr. Brijesh Lahoti, said, "In India, there is no problem in performing these surgeries as only the consent from parents and an affidavit is required. These are reconstruction surgeries where sex of the child is determined based on its internal organs and not just on the basis of external genitalia."

This caused the National Commission for the Protection of Child Rights to order an investigation, and the Prime Minister's Office at one point hinted that new laws could be written to shut down the practice or that doctors and hospitals participating in the practice could have their licenses revoked.

Is It Possible?

A senior consultant urologist at the Sitaram Bhartia Institute in Delhi, SV Kotwal, wrote to the Hindustan Times to justify surgical reassignment procedures for intersex infants, clarifying that this is very different from reassignment surgery for transsexuals:

Each year, many children are born with 'manufacturing defects' in their sexual organs like undescended testes. Little boys with advanced forms of hypospadias are often mistaken for girls and are even brought up as girls.

Left untreated, they grow up into imperfect adults, and urologists, paediatric surgeons and reconstructive surgeons strive legitimately to correct such defects. The surgeon correcting it is not really changing sex, he is only correcting a congenital defect. Also, such surgeries must be performed before the age of three. Correction of ambiguous genitalia is a legal and validated procedure and it shouldn't be confused with 'sex change'.

[He then compares to phalloplasty:] ... The surgery is long and taxing, particularly the female-to-male one. One of our patients spent 25 hours on the operation table! Many secondary corrections are made and the final outcome may even take a couple of years. It is only then that the person can assume his pre-ordained sexual role, albeit a sterile one. Can you imagine this procedure being carried out on 'scores' of little children in one stage in places that lack proper facilities?

We'll get to his excuses for infant surgical assignment in a moment, but his point about the complexity of F2M genitoplasty and unlikelihood of applying it to cissexed infants is worth examination. There are two main types of F2M surgeries: phalloplasty and metoidioplasty.

The former (which seems closer to what Kotwal describes) uses a graft using donor tissue from elsewhere on the body, and is a long, intensive surgery that would be probably too strenuous on a newborn or young child. It's also highly unlikely to yield a result that would be considered "passable," (as much as I hate using that word) functional and mature accordingly as the child develops.

The latter is sort of a clitoral release and then uses hormone therapy to do the rest. Most intersex "corrective" techniques rely on some existing genital formations to work with, thus averting some of the difficulties of F2M genitoplasty, although some things like rerouting / extending the urethra are performed regardless. It's highly unlikely that phallo would be performed on so young a patient, but it is conceivable that some "quick fix" surgical procedure could be developed based on metoidioplasty. But even then, again, development during puberty would be very complicated.

A medical services lecturer with the Government of Madyah Pradesh comments on the Telegraph article, saying:

It is totally a failure of media to go in to detail of the issue.I have talked to all the pediatric surgeons of the city and I am confident to say that Nothing like this is going on in Indore, it is a baseless news. As a resposible office bearers of IAP "Indian Academy of Pediatrics" I would like to say categorically that this is the case of negative journalism on the part of HT. is also shocking and surprise for me. We should condemn it as news paper has opened another areas of discussion and need for the parents who are desirous of son, in-turn which will again confuse our society.

To which Zoe Brain adds:

It wouldn't be the first time that a newspaper has published a sensationalist beat-up regarding Intersex issues. It also wouldn't be the first time an Indian state government official with an obvious political agenda has tried a cover-up.

So there you go. I've intentionally given you the back story before the answer, because it's important to know the sociopolitical forces providing this backdrop, and care about the surgical assignment techniques on infants (whether intersex or cissexual), since the practice is still very often damaging.

The Answer

The Hindu reports that this is indeed in reference to the surgical assignment of intersex infants. They also cite medical professionals, but not an investigation, which might be a noteworthy distinction to make.

However, that report still whitewashes the phenomenon of sex selection, and leaves the impression that it is purely biology that is playing into the decision to assign male gender and perform male genitoplasty. Given the reality of the disparity in India, there is more than ample reason to question that.

It also discusses the surgical assignation of sex as though it's some saintly task performed by the medical community. It isn't.

From their report:

At least one figure -- which sparked off much of the national alarm -- is provably dubious. The article said that "genitoplasty experts of Indore say each of them have turned 200 to 300 girls into 'boys' so far," listing seven such experts.

"Well, three doctors told us they had done about 200, 300 surgeries," Mr. Majumder told The Hindu, not explaining how that figure was then extrapolated to include the remaining four doctors. He then admitted: "Initially, the doctors may have thought our article would be a good advertisement for them, so they may have exaggerated."

Most of the rest is peppered with glee at having caught a rival newspaper in the embarrassing situation of having headlined with a badly-researched story.

The bottom line is that it's most likely that cissexual infants are not being surgically assigned a gender. But it's also most likely that sex-selective practices are resulting in intersex infants being overwhelmingly being assigned to male - probably whenever it's biologically possible - regardless of how they might identify later in life. That is speculative on my part, but based on the consideration that with all that has been written thus far, there has likely been some real disparity that sparked the several initial reports.

"Imperfect Adults" and the Perceived Nobility of "Normalizing" Intersex Children

With regards to Kotwal's and others' excuses, OII Australia counters that these procedures are as harmful to intersex children as they would be to cissexual (non-intersex / non-trans) children:

... There is no secret formula, no special knowledge or technique, no machine that goes ping. The only way they can determine the sex of the infant is to ask them when they are old enough to speak. All children, or almost all children, whether intersex or not, know what sex they are. Their brain tells them so. There is no special procedure or special evidence other than this.

... These surgeons are imposing a gender - whether boy or girl, man or woman - on these children regardless of whether they are intersex and male, or intersex and female, intersex and neither male nor female, or intersex and both male and female. The surgeons are creating confusion where none exists for the child.

Surgical assignment of intersex infants stems from Dr. John Money's philosophy that gender identity is malleable and can be changed through clinical conditioning. When Money wrote about this, he pointed to his star example, "John/Joan," who was an infant whose penis was burned off in a circumcision accident -- and then under Money's guidance was raised as a girl. "John/Joan" is now known to have been the late David Reimer. In 2000, Dr. Milton Diamond uncovered the truth about David Reimer's tragic story and John Colapinto broke the story. He recaps for Slate Magazine:

After David's suicide, press reports cited an array of reasons for his despair: bad investments, marital problems, his brother's death two years earlier. Surprisingly little emphasis was given to the extraordinary circumstances of his upbringing.

... At age 2, Brenda angrily tore off her dresses. She refused to play with dolls and would beat up her brother and seize his toy cars and guns. In school, she was relentlessly teased for her masculine gait, tastes, and behaviors. She complained to her parents and teachers that she felt like a boy; the adults - on Dr. Money's strict orders of secrecy - insisted that she was only going through a phase. Meanwhile, Brenda's guilt-ridden mother attempted suicide; her father lapsed into mute alcoholism; the neglected Brian eventually descended into drug use, pretty crime, and clinical depression.

When Brenda was 14, a local psychiatrist convinced her parents that their daughter must be told the truth. David later said about the revelation: "Suddenly it all made sense why I felt the way I did. I wasn't some sort of weirdo. I wasn't crazy."

Although not intersex himself, Reimer's story has resonated over the years with many intersexed people (and many transsexuals as well, although no concrete connection to intersex has yet been determined for transsexuality). To be fair, there are intersex people who are happy with the sex they live and/or have been raised as, but there are also many who identify as the opposite sex or as non- or dual-sexed in some way. Many intersex advocates call for surgical assignments to be delayed at least until the child can be old enough to indicate who he or she is.

Organisation Intersex International has an official position on surgical assignations that reads in part:

We campaign against all non-consensual normalisation treatments of infants that are not medically necessary and favour the right of all intersexed children to determine their own sex identity once they are capable of communicating it to us. Furthermore we advise parents to respect the sex identity of their children and to do all that is necessary so that their children can live according to their choice.

Once the child has communicated clearly their own sex identity, it is crucial that the child's identity be respected both by the parents, physicians and therapists who are caring for the child. All steps should be taken to respect the child's own sense of self by being given access to all health care necessary to facilitate life in the sex the child considers most appropriate.

Therefore, we are campaigning in favour of changing the current medical paradigm concerning nonconsensual normalisation treatments and against the diagnosis of gender dysphoria or GID in intersex individuals who feel they were assigned the wrong sex. OII affirms that the true sex of the child is determined by their own inner psychological perceptions and that the right of individual intersex persons to affirm their own sex without medical or governmental interference should be a basic human right.

Curtis Hinkle also goes into further detail in an article entitled "Mutilations or non-consensual normalization treatments?" (it's worth reading the whole article):

... Instead of insisting on a gender identity assignment as quickly as possible, OII is convinced that it would be better to inform the parents of their child's physical difference in such a way that they will be able to make informed decisions about the real health needs of their child (and not all this focus on which gender identity is best for the child which is what we are doing now). Understanding the intersex variation and the anatomical, endocrinological and other physical differences are very important and this can be very difficult for parents who are usually not specialists in genetics or anatomy. They need help to manage the health care decisions concerning their child and understanding their child's body is what is important - not spending weeks deciding what gender identity is most appropriate. This wastes precious time and it makes the parents feel their child is so different that they can be overwhelmed, shocked and confused....

This matters, because the surgical assignment of gender to intersex infants is not simply something that happens in India. It happens in North America on an almost routine basis, although not all pediatricians and surgeons encourage the procedure.

I want to be clear that I don't speak for intersex people, and defer to the experiences of those who have been surgically assigned as infants. When in lieu of those experiences, I present what I know to the best of my ability.

But if this story can finally draw attention to the plight of intersex children, then that's probably a good thing.

Resolution

If this situation concerns you, here's what you can do:

  • Support intersex organizations both locally and internationally, when you can find them. Organisation Intersex International (Canadian site) is a worthy authority, and they have localized information at oii usa, Intersex in Australia, OII-English (UK), OII Aotearoa New Zealand and more. In India, there is some information available through the EKTA Foundation.
  • If you are a part of the medical establishment, investigate whether surgical assignation of intersex infants is performed in your area, and promote a harm-reduction approach that allows a child to grow and develop, and decide when they are better able to communicate who they are.
  • If you're concerned with the disparity in value placed on women in nations like China, India and elsewhere around the world -- disparities at the root of sex-selective abortion and sex-selective surgical assignment, do a search for organizations in those nations directed by women, and donate what you can to support them. It's always wisest to support existing programs directed by people who live in those cultures and understand the nuances, than to presume a North American organization will just know best, but if you don't have the time and resources to seek those organizations out, then support Human Rights Watch, which works with many of those organizations.
  • I don't know if EKTA or any other organization is looking specifically into whether sex-selective practices are influencing decisions on surgery in India (or China, or elsewhere, for that matter). If I learn of any, I will follow up this post with information.

(Crossposted at Dented Blue Mercedes)


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Lot of information here, Mercedes. Thank you for your hard work, it was quite an interesting read.

It's not too surprising to see the far-right get their panties in a twist (nuance totally intended) over something like this without all the facts. First thing I remember thinking when I heard about it was, "Wait, I thought phallo- was a multi-stage pain in the ass of a surgery...no infant would make it."

True. The reason I think some of us weren't sure at that time was that phallo wasn't the only surgery that could have been employed. But from the far right perspective, they tend not to know much about either surgery, and probably latched on to the story solely because it seemed to lend itself to validation of some of their activism.

I've read this article a few times now. I have read a lot of medical papers on hypospadias, cryptorchidism and other genital variations. I have a lot of trouble with expressions like "cissexual", especially where it implies that clear lines exist between who is intersex and who is "cissexual". I don't want to lose myself in that controversy at the moment, however. Your article is well written and informative, IMHO. The medical schools in India, I have it from a very reliable source, are excellent and very competitive. Indian urologists are prolific writers on the subjects of orchiopexy, various hypospadias surgeries and other other intersex surgeries. Their techniques seem to be very advanced and there certainly does seem to be a strong bias toward normalization and conformity to what is actually a nonexistent sex binary and, also, a strong interest in reinforcing male sex assignments. The quote from the urologist which states:

The surgeon correcting it is not really changing sex, he is only correcting a congenital defect.

is an outlook one could spend a lot of time analyzing and criticizing. I strongly disagree with this way of looking at things and really beg to differ with the assertion that the surgeon is not changing sex, even if there is an element of truth to what he is saying.

The history of intersex surgery does not begin with John Money. M. Duplay had performed hypospadias surgeries in the late 1800's and Archibald McIndoe had developed advanced techniques before WWII but it appears that even as far back as Galen there was some understanding:

The dictum, There is nothing new in surgery not previously described, is particularly true of hypospadias. The major significance of chordee was fully appreciated by Galen in the second century A. D. and then almost forgotten until Mettauer in 1842, all previous surgeons overstressing the position of the orifice. Mettauer recognised skin shortening as a cause of chordee, a fact not rediscovered until 1967. Urethroplasty from penile skin in situ was well described by Thiersch in 1869 and Duplay in 1874; additional covering skin flaps were developed in 1892 by Lauenstein. The modern enthusiasm for pedicle tubes from prepuce was first employed by Van Hook in 1896, Rochet in 1899, Hamilton Russell in 1900, and Mayo in 1901; the buried skin technique of Denis Browne was described by Duplay in 1880, although attributed by Browne to Hamilton Russell in 1915. Even scrotal tissues were incorporated in repairs in 1860 (Bouisson). Beck, in 1898, practised a repair for balanitic hypospadias very similar to the modern MAGPI repair, and free grafts, so popularised in the last 20 years, were performed by Nové-Josserand in 1897. We have certainly advanced from the era of the first millenium A. D., in which the treatment was amputation beyond the orifice, but almost all present-day techniques are well-founded in ideas developed by enterprising surgeons of the last century.

PEDIATRIC SURGERY INTERNATIONAL
Volume 12, Numbers 2-3, 81-85, DOI: 10.1007/BF01349969

I won't reply to Cristan Williams' post. I find the concept of "separatism" extremely disturbing, particularly because of the insistence that people who opt for certain medical procedures or reject a sex assignment be separated from the rest of humanity and lumped into a trans category. I also resent being drafted into a political movement I never consented to join and further being categorized as a "separatist". I recall that, in her last post, I am pretty sure, that references to to "biological females" and, possibly, "biological males" were made. Unfortunately, life is a lot more complex than that. At least 1.7 in 100 are not simply "biologically male" or "biologically female". Such expressions are very misleading. All of us are unique, some have greater differences than others.

I found this article last night in a journal put out by the Society for Pediatric Urology. I went to high school with the editor of this publication, Tony Caldamone. He works here in Providence, where I live. I have become very interested in his writings for personal reasons, which I won't go into. Anyway, if you scroll down to the "Laparoscopy in Disorders of Sex Development" article, you will find a very graphic example of just how senseless expressions like "biological male" and "biological female" are and how one shouldn't assume that available tissue is lacking in those with an xx karyotype. Here is the issue the article appears in:

http://www.ciruroped.com/urolaparoscopia.pdf

This is an extreme example of a variation of sex differentiation, however. Hypospadias occurs in 1 in 250 male assigned births. Some of those male assigned births will karyotype as xx. There are many, many variations and reasons and possible reasons for the variations. There are many graphic illustrations, photographs and videos available on line. Many times the phallic structure has to be released the way you describe a clitoris is released in a metoidioplasty. Genital tissue is homologous between male and female. The whole subject of what sex actually is is much more complicated, than the way it is most often discussed. Concepts such as "birth defects", "conditions", "correction", have huge implications, mostly negative. Such concepts do not validate non-consensual surgery, nor should they justify consensual surgeries. These things are at least as much about sex, however, as they are about gender. Function is involved, whether in a positive way or a negative way.

No, and when I use the term "cissexual," it's to the best of the limited information available to us, and with the acknowledgment (as above) that we don't typically do genetic testing, so never really know for sure. When I first looked into that myself, I was told that the tests were too expensive to do without a pressing visible need (of course, in Canada, many of these tests are funded by public heath care -- if I was inquiring within a system where I could pay cash, that answer might have been different). When we later found an underdeveloped ovary in an ultrasound while addressing another medical condition, I'd already decided to transition, so then, the answer became "the point is moot now, so it's not necessary." So I still don't really know anything for certain.

True on the history (or at least that Money wasn't the first -- I don't know the history of "corrective" procedures that much). I brought up Money & David Reimer, because they provide the most vivid and further-searchable example on the harm of "corrective" surgery. And because Money largely shaped the attitudes and excuses of everyone who came afterward.

Within community (as opposed to medical spheres and elsewhere), references to "biological females" and "biological males" are still fairly common outside some of the more community-active and written fora on trans issues -- something I see as more of a limitation of the evolution of language than any intent to harm. But it's frustrating nonetheless.

underdeveloped ovary in an ultrasound while addressing another medical condition, I'd already decided to transition,

Are you speaking for yourself?

I thought your article was well written and informative. The impression I get is that being intersex is knowing you never have to wonder about whether you are. I've looked into these things. I have found that the cost of discussing these things when you have children that you raised can be very high. I guess that doesn't stop me, though. :)

I'm going to leave that there for the most part, Mercedes, except to say I have been told that certain matters were moot that made a big difference to me. Physiology makes a difference.

I am glad you looked into this. These stories persisted on my Facebook page for a long time and also in several other places on the internet. It would be interesting to have someone from EKTA provide some clarification. I do remember a lot of people were upset that the uproar that surrounded what Dix Poppas was doing made no mention of intersex. I think the information you provide sheds a lot of light on how the stories about what is going on in India may have resulted from distortions based on a shallow understanding of the nature of normalizing surgeries in intersex children.

"Are you speaking for yourself?"

Yes, that was my experience, and "the point is moot" was the new excuse that doctors made to not investigate. I don't usually bring it up, since that's usually followed by a cacophony of accusations, but I also realize that my experience is quite different from someone who lived all their lives with the ever-present effects of AIS or CAH.

I was lucky, I suppose, in that the finding was actually disclosed to me (very possibly because I'd already talked to my family doc about being trans, and to him, this sort of provided a reason). I know of two other cases here where clinicians went out of their way to hide or deny evidence of intersex, until doing so became impossible and a medical situation required disclosure.

> ...it's also most likely that sex-selective practices
> are resulting in intersex infants being overwhelmingly
> being assigned to male - probably whenever it's
> biologically possible - regardless of how they might
> identify later in life. That is speculative on my part, but
> based on the consideration that with all that has been
> written thus far, there has likely been some real disparity
> that sparked the several initial reports.

Such a shame that you too got taken in by this and missed the trans aspect entirely.

The initial newspaper report included a box of details that stated that all the children had testes. So they were not female, would not need testosterone doses, and the entire "scare" was a fabrication. Attached to the original story was a podcast of an interview with the local reporter, who was very unimpressive. She had seen no files and had no evidence. She just thought that children being made male must be similar to the selective killing of female fetuses.

The story claimed there was a need for guidelines, but Indian surgeons, who are very much a part of the international medical community follow the international (US/European) guidelines.

The paper also turned it into a call for regulation of gender surgery. And by probably no coincidence at all, the city in question is one of the main centres for transsexual and hijra surgery. The hospital providing those service immediately stopped. That's the trans angle.

Further reports say that a high-powered investigative team found no irregularities in infants surgery.

Instead of scare stories demanding new laws and regulations, the papers there might be better campaigning for the effective enforcement of existing laws against dowries and sex-determining ultrasounds, that lead to the destruction of some many female lives.

You wrote:

"The hospital providing those service immediately stopped."

Interesting. Yes, I did miss this. Is there indication that they will resume now that the investigations are done? I've not seen anything in the writing to suggest that anyone thought that changes were warranted for trans-related processes.

Its too early to know the long-term effects.

An inserted "facts" box in the original (Hindustan Times - linked above) story called for "India-specific medical guidelines for sex-ressignment surgery", and the story contained three assertions that there were "no proper laws".

One associated story in the same paper, headlines "PMO takes note, hints at new sex surgery law" (linked from its web page) had a member of the Prime Minister's Office saying "new laws could be framed, if necessary, to deal with such medical processes", and the brief of the investigation was said to include "awareness campaigns to be planned by the state on the effects of sex-change operations."

Another, "Call for checks on sex surgeries", says "the Medical Council of India has called for the formation of a medical board of experts to decide on the need for such a surgery in every case, and stringent checks in all cities", and quotes Prof Gautam Sen, member, board of governors, Medical Council of India, and director of surgical education, Association of Surgeons of India, as saying "There should be a medical board to decide if the surgery is medically required. It has to be a responsible decision made by a panel and not a decision between a parent and a doctor.”

None of those stories made a distinction between surgery on children and adults.

Incidentally, the newspaper responsible for this censored every attempt I made to leave factual corrections in its comments. So this is deliberate misinformation by what was regarded as a reputable paper. I would interpret this as being due to them thinking that they are pursuing some great moral good. Ending, or restricting sex change surgery might be seen as that. The London Guardian was persuaded to follow that path for some years by its pseudo-feminist columnist Julie Bindel and gay journalist David Batty.

It might be useful context to know that hijra/aravani/kathoey surgery, and indeed full healthcare, is currently being taken into government hospitals in the the most southerly Indian state, as part of a new rights package, but that the doctors have taken to describing those who have done the surgery for thousands of years up to this point as "quacks", which implies a threat of prosecution. What we may be seeing is a national campaign to impose controls upon the surgery provided. Controls not originating from those needing the surgery but from scare-mongering outsiders; perhaps pseudo-feminists.

In nearby Thailand, a campaign by gay activists (claiming transsexual/kathoey/sao braphet song young people are gay boys who need time to realise their mistake), and, it is believed by ILGA and WPATH, recently had psychiatric assessment and a minimum age of 18 imposed for sex reassignment surgery (and 21 without full parental consent), destroying access to the world's best surgeons at 16, which had been of great relief to many young people from all countries, with no evidence whatsoever of regrets.

This might be a hoax story. Some top Indian dailies are having found to not have done the proper groundwork:
http://www.thehindu.com/news/national/article2296797.ece

Additional information about the report that was returned: http://timesofindia.indiatimes.com/india/Indore-sex-change-ops-report-a-figment-of-imagination-NCPCR/articleshow/9378041.cms

These findings are consistent with the discussion above.

The term for a series of stories, including real quotes for the office of the Prime Minister, based on nothing but lies, is not "hoax". The words "scandal rag", "scare", and "gutter journalism" come to mind. Also "Libel". All concerned, on the Hindustan Times, should lose their jobs, and a great many of those who picked the story up elsewhere, without using their brains at all, should be ashamed, and in future be regarded with deep scepticism.

I don't know if you'll see this, Mercedes. This incident is very unfortunate. There is a lot of misunderstanding that's been perpetuated in this thread. There really is no adequate definition for male and female. The question is a complicated one. The presence of testicles does not necessarily make one male. Sometimes testicles are necessary for secondary female characteristics. There are definitely times when exogenous testosterone is needed to develop male characteristics in people who have testicles and want them, both their testicles and male characteristics.

I don't know of David Batty but I would agree that Julie Bindel's anti-SRS stance is oppressive. I can see how that plays into the very complex chain of reactions to a sensationalist article full of misinformation, purely for the sake of shock value. The issue is non-consensual surgery. Someone must have brought that issue up in a more serious way for the Hindustan Times article to have been written. Obviously the writers and editors at the HT have no concern for the complex issues involved.

Orchiopexy and hypospadias surgeries are consequential. Imposing such surgeries without a person's consent can carry a lot of culpability, especially if one does not have a sense of self that is compatatable with a sex that is being reinforced. Reinforcement involves changing a person from what they are. A person should have access to information about the complexities of sex differentiation. There is a lot more involved than being at the extreme opposite ends of the Quigley and Prader scales. There are a lot more variations of sex differentiation than complete, or even partial, androgen insensitivity syndrome and classic congenital adrenal hyperplasia.

After a person has been properly informed of their options for adjustment to the way THEY feel about themselves, they should have the best medical care possible available to them so they can choose what's best for THEM, not a medical panel, not someone's parents. After they have made their medical choices for THEMSELVES they should be accepted without reservation as the sex they choose for themselves in a world that only sees two sexes. All of the things being discussed here are things that exist in the physical realm, whether the choice is made by the person affected or others.

The large issue underlying all the ignorance and distortion is consent. There really does not have to be such a conflict between intersex and transsexual advocates. It hurts both groups.

I don't know if you really did miss the trans aspect of this whole issue. As far as I can tell, through all the distortion, it seems very difficult to tell whether there was an anti SRS aspect to this. The nonconsensual childhood surgeries aspect to this was very obvious, however, with constant references being made to pediatricians. I don't think there is much question about that. There is none in my mind. That said, with the constant emphasis on gender expression at a place like Bilerico, the complexities of sex and the physical aspects of medical intervention gets completely lost. I understand the need for concern for kids like Larry King and gay men who may have a very feminine way of presenting themselves but for other people physiology and medical intervention are the deepest concerns. It is an injustice not to be attentive to that. I don't think LGBT forums are good places for these concerns to be adequately be discussed. The Hindustani Times is not the only place one finds ignorance and gross distortion.