Forty seven-year-old Sagar finally got a body that aligned with his gender identity after going through a sex reassignment surgery at a Mumbai hospital earlier this year. But he had to face the severe pain and trauma of a botched procedure before this transition.

In 2010, Sagar, who was assigned female at birth and named Subadhra, approached the Thiruvananthapuram Government Medical College Hospital to have a gender reassignment surgery because the hospital offered it free of cost. Though the hospital had no history of performing such a complicated procedure, doctors there agreed to take on the challenge.

A complete gender reassignment from female to male takes about five surgical procedures. However, in January 2017, after what Sagar claims has been seven long years of medication, counselling and 13 surgeries, he was in severe pain and nowhere close to having functional male organs. Sagar told that the chief plastic surgeon at the Thiruvananthapuram Government Medical College Hospital had attached his penis at an incorrect position on his body, rendering it completely unusable. By the end of January, Sagar had contracted infections and his penis was oozing pus, leaving him unable to even urinate.

“There was a time I thought I was going to die, such was my condition,” said Sagar, anguished and now recuperating at his home. “The hospital had told me that it was the first time they were doing such a surgery. But if they were not sure they could do it properly, why did they do the surgery at first instance? How will I know about their competence? Are they playing with lives?’’

The Thiruvananthapuram Medical College Hospital has dismissed Sagar’s allegations and says that he is ignorant of the medical process. The hospital claims that all procedures performed on Sagar were done with his full consent.

Despite this, Sagar has now approached the Kerala State Human Rights Commission and the state health ministry with complaints of medical negligence against the hospital. The Chairman of the Commission Justice Mohanadas confirmed to that a case has been registered against the hospital and the chief plastic surgeon who operated on Sagar.

“Prima facie there seems to be a case of criminal negligence against the doctor who performed the surgery on him,” said Mohanadas. “After doing so many surgeries it seems they have still not been able to transition him into a man’s body. The question is why did they take up the task if they are not able to complete it? So we will have to see if there is purposeful negligence involved in this.”

The commission, while ordering a thorough probe into the incident, has also sent notices to the superintendent of the hospital as well as the to the state health secretary. For a state that declared a progressive transgender policy in 2015, the 60th year of its formation, Sagar’s case is not very encouraging.

Painful journey

Sagar remembers the agony of his school days when he was unable to connect to girls his age and was also unwelcome among the boys. “From a very young age, though I was a girl physically, I was showing all the signs of being a boy,” Sagar recounted. “But society, for obvious reasons, was not accepting me. Even at home I faced a lot of issues. Finally my father took me to a hospital and we decided to go for sex reassignment surgery.’’

Sagar’s plans had to be put off twice, once because his father died and then because he had no money.

In 2010, he went to the medical college hospital after selling off his property. Even though treatment at the hospital was free, he would have to pay for stay in the wards and for his medicines. In 2013, gender reassignment surgeries were only allowed in Kerala after submitting proof of gender identity disorders to the government and getting official permission to have such a procedure. Sagar made sure he got these permissions.

After hormonal and psychological treatment, Sagar underwent chest reduction and nipple grafting procedures in 2013. This was then followed by a hysterectomy to remove the uterus and a vaginectomy to remove the vagina. Though all these procedures are part of gender reassignment from female to male, Sagar claims that the doctors at the hospital repeated the operations several times to get the desired result.

“Till then it never crossed my mind that they would actually use a trial-and-error method,” said Sagar in tears.

The final step of gender reassignment is creating a penis or phallus. In Sagar’s case it was done with a phalloplasty, in which the phallus was created using tissues from his thigh. The surgery was carried out by the head of plastic surgery Dr Ajay Kumar and his team. Sagar said that, to his horror, the procedure had to be repeated three times after the first attempt in July 2016 – in October 2016 and then twice in January 2017.

On January 21, an exhausted Sagar was shocked when he looked in the mirror. His new penis was stitched high up on his right leg, such that he could not stand up properly or pull up his trousers. The hospital however discharged him on January 25 and announced to the media that the state’s first gender reassignment surgery operation had been a tremendous success. Back home, Sagar soon developed complications – his penis started bleeding and quickly became infected.

“I thought I was going to die,” said Sagar. “I even contemplated suicide.’’

Corrective surgery

Luckily for Sagar, Arav, who had a successful gender reassignment surgery a few years ago in Mumbai, read about the Sagar’s surgery and went to meet him.

“He [Sagar] could not even get up,” said Arav. “I don’t understand what this hospital was doing. I have undergone this surgery. It is at the most three or four sittings and I never faced any complication. I am not undermining the expertise of the doctors here, but there was something seriously wrong.’’

Arav took Sagar to Kokilaben Dhirubhai Ambani Hospital in Mumbai, where doctors performed a corrective surgery to remove the infected penis and fitted him with a new organ grown from a flap off his knee. Though the doctors at Kokilaben hospital refused to comment on the case saying patients’ details are confidential, the summary of Sagar’s discharge slip from the hospital confirms that a corrective surgery had indeed been performed. The discharge summary adds that Sagar was presented for “correction of the shaft with neo-perineal stenosis”, or correcting the position of the penis and the urethra.

Stepas in a standard female-to-male gender reassignment surgery.

Sagar who has now approached the Human Rights Commission says retribution is the last thing on the mind. “I don’t want to point fingers at any individual for what I went through,” he said. “But this should not happen to another person. If a hospital is not fully equipped for such surgeries they should refrain from it and only experts should do this.”

The hospital’s defence

The Thiruvananthapuram Medical College Hospital deny Sagar’s charges. Plastic surgeon Kumar told that Sagar did not come back to the hospital for his full treatment. “It was a multi-staged process that we had planned using the anterolateral thigh flap, which in layman’s terms means taking a piece of your tissue from the thigh and converting it for use in another part of the body,” he said. “In Sagar’s case, it was used as the phallus. Now this is an internationally accepted procedure. Problem is that Sagar did not come back for the entire procedure. He went back home, got some infection and concluded that all we did was wrong.’’

Kumar also added that a medical board had been specially constituted to look into Sagar’s case during the course of treatment.

When asked why, if the procedure was not over, the hospital announced to the press on January 26 it had conducted a successful gender reassignment surgery, the hospital did not give a direct answer.

Sagar ended up spending close to Rs 10 lakhs for his treatment including the final corrective surgery at Kokilaben Dhirubhai Ambani Hospital in Mumbai to finally get back on his feet. His gender reassignment is complete even though he has a few minor procedures and counseling to undergo.

“This was a lifetime investment for me,” he said. “Now whatever little saving I had has been completely exhausted because I was pushed to taking corrective steps in Mumbai.”