Central Asia Journal No. 67

 

Portrayal of Gender Dysphoria in Khyber Pukhtunkhwa

Syeda Kaniz Fatima Haider*

Abstract 

This research paper discusses a study of male- to- female gender dysphorics in Khyber Pukhtunkhwa. The sample consisted of 217 gender dysphorics age ranged from 15-55 years. A detailed questionnaire based interview method is used for this meticulous study. The questionnaire was divided into four parts: a) the social facet; b) personal beliefs; c) sex change issues, and d) gender diversity. Results showed though the meaning and uniqueness of male-to-female gender dysphorics in Khyber Pukhtunkhwa province may diverge in a number of ways from those in other parts of the world but many male-to-female gender dysphorics have numerous characteristics parallel to them. The study further found that the exceptionality of the male-to-female gender dysphorics in KPK province is predisposed by cultural and religious factors. Results showed strong influence of the Islamic religion and culture on them particularly on their insights towards a sex change operation.

Key words: Male-to- Female Gender Dysphorics, Castration, Culture, Religion.

Introduction

Normally people in Pakistan are neither well versed in, nor eager to be familiar with the incompatible position of gender dysphorics. They ridicule them and usually fail to properly describe their odd mannerism. Though they are short of adequate information about the origins and discrepancy of gender dysphorics, yet are really very much familiar with gender dysphorics, because they see them around and acknowledge them as part of their culture. Even the most educated group uses the phrase gender dysphoria as an umbrella term for different discrepancies. The yearning to wear in the clothes of the opposite gender is a observable fact that has existed in every age and culture and was termed as "Transvestism". Many male-to-female gender dysphorics besides having the feelings of belonging to the opposite sex also desire to cross-dress believing that they have not only been given the wrong body, but also the wrong external sex characteristics. Therefore they want to be operated upon so that their body resembles that of the opposite sex. Benjamin coined the word Gender Dysphoria, a term, which has been used more and more in recent years.
Gender dysphoria in our province gives rise to many problems such as social, medical, ethical and legal; despite this fact not much experience has been gained to discover the causes or treatments. The writings to date on this subject consist of assumptions and the decisions that physicians have made in cases of transsexualism. Most of the important assumptions have been based on wobbly theoretical reasoning. Researches have suggested the need of systematic examinations of transvestites and transsexuals. They believe that such people have greater social and psychological problems than do those with anatomic intersex states.
Gender dysphorics as diverse groups of people show some kind of variation from cultural norms in their gender expressions. The most helpful definition of gender dysphorics found according to American Psychiatric Association was that they are a group of people who display behavior different from that "normally" expected from a person of their birth sex. This definition neither explains this diverse behavior and the causes that generate it, nor does it express the diversity of the group it refers to. It also does not adequately allow understanding its sub-groups such as cross-dressers or transsexuals who are more readily identified in the community but still show a high degree of diversity within their groupings.
Male-to-Female gender dysphorics are worldwide, however, the expression of gender dysphoria varies from culture to culture, and hence the different types. The present researcher has classified them under five major headings. Two gender identity sub- systems in any human being were hypothesized as "Masculine and feminine". In this study the strength of both subsystems are related to the degree of gender dysphoria. Male-to-female gender dysphorics with high proportion of masculinity and low proportions of femininity were grouped as transvestites, while male-to-female gender dysphorics with high proportion of femininity were grouped as transsexuals. The Model of gender dysphoria as shown in the table-1 also includes intersex that resembles transgender and lives the gender they like for explaining the transgender phenomena. Brief description of each type and category of gender dysphoria is given below:

Table1 – L

This research is an endeavor to investigate the basic grounds of this discomfort beside other motivating factors, which play an imperative role in enhancing this condition. The rationale of this paper is to show that male-to-female gender dysphorics in our province have similar characteristics to male-to-female gender dysphorics in other parts of the world. The focus of this article is the comparison of the same distinctiveness. The following table provides comprehensive information about the similarities of gender dysphorics of Pakistan with gender dysphorics from other parts of the world.

Table 2

Now the question is why people who belong to different cultures have many things in common? Anne (2003) answer this question in her research article Notes on Gender Identity Disorder she wrote that “hormonal impact during the development of the fetus effect the brain to develop in a way which is incompatible with their chromosomes, genitalia and gonads. This results a quite unusual example of XY females, i.e. persons whose apparent bodily sex appears to be that of a man, but whose gender identification is female or vice versa. Persons having XX chromosomes and the observable physical sex of female may have the brain biology associated with male gender identity”. Hence the problem of one's gender identification, whether male, female or somewhere on the spectrum in between, is ingrained in the brain and is considered by the individuals apprehension. Research shows that this condition is mainly determined before birth and is more-or-less stable thereafter. The holy verses of Al-Quran clearly indicates that “He it is who shapes you in the wombs as He likes, there is no God but He, the Mighty, the wise.”
Latest research offered a conceptual scheme for defining nature . It explains that nature starts out the human developmental process by means of the female schema as a base for a male embryo to develop. Y chromosome (inherited from father) notifies the embryo to distinguish and develop male genitalia otherwise embryos without the factor continue to develop undifferentiated as female. It is very important to understand the phenomenon that the manner the fetus develops and functions in terms of sex and gender depends on its inborn sensitivity to particular hormones. These hormones will influence the development of a brain of growing fetus (which will identify as male or female) and a physical sex development (which is consistent with and typical of each gender).
The medical and academic community in Pakistan generally agrees to define  male-to-female gender dysphorics as that espoused by Western scholars. International Foundation for Gender Education (2004) , explains that “the term gender dysphorics can refer to both male-to-female gender dysphorics i.e. males who want to be females in every aspect and female-to-male gender dysphorics; those are females who want to be males in every aspect”. Similarly Teh (1998) clarifies that “transvestites therefore fluctuate from male-to- female gender dysphorics because they are males who cross-dress as females”.

Gender dysphorics in KPK province have many things in common with the rest of other gender dysphorics from all over the world. The most remarkable difference among them is about sex change surgeries. Though sex change operation or sex reassignment surgery is the ultimate goal of the majority of gender dysphorics in our province even than the number of castrated male gender dysphorics are very small compared to non-castrated male-to- female gender dysphorics. The article emphasizes the influence of the religion Islam and Pukhtoon culture on Muslim male-to-female gender dysphorics, especially on their imminent towards a sex change operation.     

Sample

The sample consisted of 217 male- to-female gender dysphorics were drawn from the four cities of Pakistan where the male- to-female gender dysphorics usually live. The cross sectional study was conducted to find the frequency of the meaning of the term Gender dysphoria. Three hundred questionnaires were distributed randomly among male-to-female gender dysphorics at Peshawar, Mardan, Charsada, and Swat Questionnaires required less than one hour to complete and return individually. Some of the responses were unidentifiable and was outside the scope, eighty three responses were invalid and the total valid responses were therefore 217.

Results

 

Fig. 1. Gender Identity and Self-descriptions (N=217)

Figure – 1 represents the most acceptable definitions given by the respondents to describe their discomfort. The most popular answer given was "Woman trapped in male body "(44.23%) followed by "Man with feminine side "(26.26%), "Cross-dresser" (13.82%) Asexual, (10.59%) and Homosexual man (5%).

Table – 3: The Age of Onset of Cross-Dressing among Male-to Female Gender Dysphorics (N=217)

On-Set Of Cross-Dressing			Present  Sexual Orientation
Age	f	Valid %	Sexual Orientation	f	Valid %
3-5	81	37.3%	Low libido. Asexual,	5	2.5%
6-8	42	19.3%	Passive Homosexual	98	45%
9-11	13	5.9%	Bisexual	61	28%
12-14	25	11.5%	Heterosexual	33	15%
15-17	56	25.8%	Desires relations with normal male as female	20	9.5%
Total	217	100%		217	100%

Table – 3 illustrates the age of cross-dressing and also demonstrates the present sexual orientation of gender dysphorics. Result indicates that majority of them (37.5%) cross-dress at age of 3 to 5 years, while 25.8 % of the respondents cross – dress at the age of 15 to seventeen years. The data indicates that only 5.9% of the respondent’s cross- dress at the age of 9 to 13 years.

Table – 4: The Reasons and Personal Feelings of Gender Dysphorics while Cross-Dressing (N=217)

Reasons for Cross –dress			Feelings when Cross-dress
	f	%		f	%
Strongest urge	16	40%	Satisfaction	19	47.5%
Satisfaction	11	27%	Contented	5	12.5%
Look like woman	7	17.5%	Complete	12	30%
Hate male dress	6	15.5%	Secure	4	10%
Total	217	100%	Total	217	100%

Table – 4 shows the major causes of cross-dressing and also indicates the feelings of the respondents when they cross-dress. Majority of them (40%) cross-dress for the reason that they feel contented and satisfied. The data indicates that 47.5% of the respondents feel highly satisfied when they cross-dress. It is their natural and un-controllable urge, which compels them to do so.

Table – 5: Interest of Male-to-female Gender Dysphorics in Castration (N=217)

Interest in Castration	f	Valid %
Not at all	154	71%
Looked into the possibility	45	20%
Interested	18	9%
Total	217	100%

Table – 5 indicates the most interesting finding of the research was about the preferences of gender dysphorics regarding castration. When the respondents were asked that to what extent they are interested in sex reassignment surgery. Results indicate that the majority (71%) of them answered they are not interested at all, while 20% will look into the possibility, only 9% showed interest in castration.

Table – 6: Reasons, preventing Gender Dysphorics from Castration (N=217)

Reasons	f	Valid %
The fear of God and Day of Judgment	108	50%
The high expenses involved	15	7.5%
The absence of trained surgeons in Pakistan	12	5%
The hope to be accepted in the family	39	17.5%
The fear of the refusal of society to bury the castrated	44	20%
Total	217	100%

Table – 6 indicates that castration is not undergone by Muslim transgender mainly because their religion (Islam) does not permit it. Majority of the respondents were afraid of God and day of judgment (50%), absence of trained surgeons in Pakistan and the high operating costs involved in going abroad also discourage the male-to-female gender dysphorics to undergo the operation. Many of the male-to-female gender dysphorics, in order to be accepted in the family promise their parents not to undergo the operation. Also the fear of the refusal of society to bury the castrated according to the Muslim rites prevents the practice.

Conclusion

Studies have shown that it is difficult to the  sufficiently explained gender dysphoria by social aspect. Actually it is a very multifaceted phenomenon that needs the elucidation of natural ,ecological and   societal  reason. certain people have been living out the role of the opposite sex since centuries. Mankind has recognized cross-dressing and history has also witnessed men who dressed and act as women. Male-to-female gender dysphorics in KPK basically share the same characteristics as male-to-female gender dysphorics in other parts of the world. Muslim male-to-female gender dysphorics in KPK have been brought up with this belief that they are non-entities in society as a result most of them are reluctant to undergo the sex change operation. It is because that they think that when they die nobody will carry out the funeral for them if they have the sex change operation. Some of them believe that society neither accepted them as females nor as males so their soul will drift pointlessly when they die. Religion is the main factor that discourages Muslimmale-to-female gender dysphorics from having the sex change operation. While on the other hand though the non Muslim gender dysphorics have fewer problems with their family members regarding sex change operations but financial constraints stopped them from sex change surgeries.
In wrapping up, it can be said that religion and culture two major forces that generally influence them and shapes their identity. They consider themselves to the category of those people who have accepted themselves female but do not want to go for sex-change operation. They know their religious limitations regarding sex change surgery, which is a normal practice with gender dysphorics from different religions in other parts of the world.

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