It has been 12 years since Thando Thengwa started the physical process of aligning her body to her gender — 12 years “of always knocking on hard walls”.
Having finally had hormone replacement therapy and psychotherapy in preparation for the gender-affirming surgery she needs, Thengwa, a transgender woman, found the inaccessibility of surgery “really discouraging, really hurting”.
“Personally,” she says, “I don’t see South Africa as a good place for trans people to live in, because it is so difficult to get healthcare services that are relevant to us. We need more surgeons and more facilities that do gender-affirming healthcare — not that, when you go a hospital, they say: ‘It’s not our priority.’”
Thengwa was one of the people who attended a recent conference in Pietermaritzburg, put together by trans rights organisation Gender Dynamix, aimed at equipping surgeons with a theoretical knowledge of gender-affirming procedures.
The number of government hospitals offering gender-affirming healthcare is increasing — with facilities in Gauteng, the Western Cape, the Free State, KwaZulu-Natal and the Eastern Cape. Gender-affirming surgeries include operations such as the removal of testes (a procedure called orchidectomy) and breasts, as well as the construction of penises.
But Groote Schuur Hospital’s Kevin Adams is the only surgeon in the country who can create penises from vaginal tissue.
“[The conference] really was ‘Trans Surgery 101’,” Adams laughs. “The main drive at the moment is to try to find surgeons who would be interested in doing gender-affirming surgery.”
The waiting list for breast and genital surgery at Groote Schuur is about 25 years. It was while attending the conference that Thengwa heard of this decades-long waiting list. “That was very sad for us. I’m 36 now, so having to wait approximately 30 years means I would only be able to have my surgery when I’m 66. So, what’s the point? ” she says.
Adams says the true picture is even worse. A minimum of 25 years is “the official line. It is actually about 50 years long. But I can’t humanely tell a patient the waiting list is actually 50 years long.”
Because of his years of experience, he can now perform these surgeries quicker. “I can perhaps do two male-to-female operations in one day,” he says, “but [one] female-to-male operation still takes a day.”
More surgeons would “definitely reduce the long waiting list”, he says.
Elma de Vries of Gender Dynamix says surgeons’ reaction to the conference was “amazing”, and that awareness among surgeons and urologists of the need for gender-affirming surgery had grown since a similar conference was held two years ago.
Urologists focus on medical issues that affect the male and female urinary tract system, as well as those related to male reproductive organs.
De Vries attributes this uptick in interest to the fact that some gender-affirming procedures are similar to those for other conditions. The technique used for female-to-male transitions — using vaginal tissue to build a penis — is similar to that used to treat hypospadias, a congenital abnormality in which the opening of the urethra is on the underside of the penis instead of at the tip.
Adams puts it down to supply and demand. “Doctors respond to demand, to need, so there are more doctors interested in doing it.”
De Vries adds that patients are not only starting to demand care, but have also started “educating their doctors”. A facility in KwaZulu-Natal hosts a support group of more than 40 trans and gender-nonconforming people. “And they have this approach of: ‘We will be ambassadors; we will be model patients and we will work with the health professionals so that we can improve access to care for the patients coming after us.’”
Thengwa is one of these ambassadors. Attending the conference “in [her] capacity as a constituent” was part of her ambassadorial role.
Speaking to the Mail & Guardian on condition of anonymity, the head of the support group says: “Sis Thando is an amazing ambassador for trans people in the province and is seen as one of the leaders. We refer to her as ‘the matriarch’.”
After years of knocking on hard walls, Thengwa is a step closer to who she really is, after her doctor referred her to Nelson Mandela Academic Hospital in Mthatha for her orchidectomy.
“I went to the receptionist and people were so friendly. It was like they were people I grew up with. I went to the urology clinic and the nurses — before I even introduced myself — were so, so friendly. They were, like: ‘Thando, this is our first encounter; please educate us so that we know how to treat people like you.’
“It makes you feel like you are living in a different world, as though the whole world has changed. You totally forget about the trouble that is waiting for you out there — the troubles that come your way as a trans person. You feel that sense of belonging in South Africa. Like, this is my home. And these are the people I want to connect with. The people who will have my back, no matter what. I have waited all my life for this,” she says.
Carl Collison is the Other Foundation’s Rainbow Fellow at the Mail & Guardian