The Gender Identity Clinic (GIC) and Gender Reassignment Surgery Clinic were set up at the National University Hospital in the early 1990s, two decades after Singapore's first sex change operation was done at Kandang Kerbau Hospital in 1971 by pioneering O&G surgeon and head of the Department of Obstetrics and Gynaecology, National University of Singapore, Prof. S Shan Ratnam. The GIC was headed by Ratnam himself until his retirement in 1995, after which leadership passed to his nephew and protege, Dr. C Anandakumar. Owing to the existence of these clinics and the skills of their staff, Singapore was one of the world leaders in SRS for 30 years, performing more than 500 such operations. This gave a new lease of life to many transgender individuals whose bodies did not match their gender identity. As one consequence of this, Bugis Street and Johore Road started to become populated with a range of transgender people from transvestites to iatrogenic intersex individuals to fully transitioned women.
Closure and reopening
In the early 2000s, the National University Hospital's Gender Identity Clinic (GIC), the offshoot of the Department of Obstetrics and Gynaecology at Kandang Kerbau Hospital formed a decade ago, was the only facility for sex change operations in Singapore. Although it helped to build Singapore's reputation as a top destination for sex reassignment surgery over the past 30 thirty years, its exact location within NUH and the services it provided were kept confidential because of the sensitivity of the more vocal religious fundamentalist segments of Singapore's population to sex reassignment surgery. Since 1971, when the late Prof. S Shan Ratnam performed Singapore's first sex change operation, there had been 500 such procedures, an average of 17 a year. But the GIC had done no male-to-female operations since 2001. Since September 2001, it had performed only four female-to-male operations.
This was because the Ministry of Health had asked hospitals to phase out sex-change surgery in the late 1980s for fear that hospital staff might be exposed to HIV. It was also reported then that the Ministry had not considered sex-change surgery as a life-saving procedure. These objections were lifted in 2001.
The general public could not find any information on the GIC on NUH's website and it was extremely difficult to interview its then consultant, Dr. Arunachalam Ilancheran. Dr. C Anandakumar, who was the specialist-in-charge at the GIC from 1995 to 2001, recounted how, during his time, consultations with transgender patients could only be done on Saturdays and after office hours, as NUH had very little interest in encouraging sex reassignment surgery. Transsexuals would also need to book themselves into single-bed wards after the operation as Dr. Anandakumar claimed "the hospital did not want the transsexuals to mix with other patients". This would push up the cost of the operation, prompting many transsexuals to head to Bangkok for more affordable treatment. However, he conceded that the situation may have changed and added that the clinic had served its purpose well.
In reply to queries from The New Paper, an NUH spokesman said, "All our patients are important to us and we care for them with respect and sensitivity due to any individual. The Gender Identity Clinic operates at the usual hours, as per all other hospital clinics. Patients stay in single room as per MOH regulation since the seventies."
Transwoman Leona Lo completed her psychiatric assessment in Singapore but elected to have her surgery performed in Bangkok. She felt that the lack of information about the GIC deterred transsexuals like herself from having the operation done here. She said, "Many of us can't be bothered to find out more about the GIC as it's so secretive about its services. It signals the clinic is not interested in helping and is ashamed of us. There's always the Bangkok and the surgeons there have done so many operations. The more operations they perform, the better they get. So we're happy to go there." But not all transgender patients were flocking to Thailand. Transwomen were still seeking help from the GIC.
In April 2001, the Gender Identity Clinic at the National University Hospital, which was the last hospital in Singapore where sex change operations were performed, closed without any fanfare. The official explanation was that the gynaecologist in charge, Dr. C Anandakumar, had left for private practice, and without him, the clinic did not have the skills to perform SRS. However, as early as 1987, the Ministry of Health had been directing hospitals to stop doing such operations on foreigners. It also discouraged them for Singaporeans, saying, "the increased danger of AIDS with such patients poses unnecessary risk to hospital staff". However, some believe that the increasing number of Christian doctors filling the administrative ranks of Singapore hospitals over the past decades had a part to play in its shutting down as cross-dressing and sex reassignment are proscribed in the Bible.
This dismayed transgender people seeking to have their operations performed locally. The online edition of the now-defunct newspaper Project Eyeball carried out a survey in June 2001 asking, "Should sex change operations be resumed in Singapore?" 39% of respondents said, "Yes, they are people with valid medical needs, like infertile couples" and 35% said, "Why not? It is legal here, as are transsexual marriages". The results showed that Singaporeans were generally quite supportive.
In June 2001, a petition organised by Jael, the founder of the transgender group "FTMs in Asia", urging the re-opening of the Gender Identity Clinic garnered 60 signatures. When asked by The New Paper about the GIC's services, an NUH spokesman replied: 'The NUH Gender Identity Clinic reopened in September 2001 to provide a service to those who request it."
The transgender community's petition was successful, with the clinic discreetly and fully resuming it services in 2003, helmed by Dr. Arunachalam Ilancheran. However, owing to the discrimination against transgender people in Singapore even within some segments of the medical community, the high financial outlay involved and the necessity for psychological clearance, many preferred to have their operations performed sans the hassles in Bangkok, which had by then become the premiere centre for sex reassignment surgery (SRS).
In early August 2001, Singapore's pioneer sex reassignment surgeon and co-author of the book "Cries from within", Prof. S Shan Ratnam, passed away from pneumonia. His death prompted his nephew, Dr. C Anandakumar to relinquish leadership of the GIC to Assoc. Prof. Arunachalam Ilancheran and to leave for private practice. Anandakumar subsequently to head SSR International Private Limited at Camden Medical Centre, an O&G centre of excellence named after his late uncle.
The Gender Identity Clinic at the National University Hospital drew its shutters for good in 2008. When asked by The Straits Times in 2014 about the Ministry of Health's stance on sex-change surgery, its role in overseeing the procedure, and why public hospitals had stopped offering it, an MOH spokesman would only say that "sex reassignment operations are not subsidised and are performed with...safeguards".
Demand, however, had not shrunk, according to private psychiatrist Prof. Tsoi Wing Foo. Since 1971, Tsoi had seen over 2,000 transgender patients, half of whom went for surgery. A psychological assessment is needed before sex reassignment surgery can be carried out on a patient in Singapore. During the 1970s and 1980s, he had roughly 30 cases a year. From 2007 to 2014, he had seen an average of 40. He did not know why surgery options here were dwindling, but speculated that it could be due to public policy changes or the personal preferences of the few doctors who had undertaken such surgery. Dr. C Anandakumar, who was the gynaecologist in charge of the GIC until 2001, declined to speak to press when queried.
Despite the fact that many male-to-female transgender patients were flocking to Thailand for their surgeries because of the lower cost and less stringent psychological requirements, female-to-male transsexuals were still seeking help from the GIC. Such operations are more complex and cost SGD$15,000 or more here. But psychiatrist Prof. Tsoi Wing Foo believed that many female transsexuals would head to Bangkok as well once the operation was available there.
Other clinics for sex reassignment surgery in Singapore
This article was written by Roy Tan.