This article was first published on Dec 28, 2014
Thirty years ago, Singapore became a global destination for sex-change surgery, with public hospitals dealing with hundreds of cases every year.
Now, such operations in public hospitals here have ceased since last year, forcing transgender people wanting sex-reassignment to look to Thailand and South Korea.
The National University Hospital (NUH), believed to be the last public hospital to do sex- change surgery, said it no longer offers the procedure. It did not give a reason, and the Ministry of Health (MOH) also did not reply specifically when asked about the issue.
The only known surgeon still performing sex-change surgery here in private practice - Dr Colin Song of Cape Clinic which opened in the middle of last year - said that "one known concern" surrounding sex change has been the spread of HIV.
It was reported previously that the authorities here asked hospitals to phase out sex-change surgery in the late 1980s for fear that hospital staff might be exposed to the virus. It was also reported then that MOH had not considered sex-change surgery as a life-saving procedure. The objection was lifted in 2001.
When asked about the ministry's current stance on sex-change surgery, its role in overseeing the procedure, and why public hospitals have stopped offering it, an MOH spokesman would only say that "sex reassignment operations are not subsidised and are performed with... safeguards".
Demand, however, has not shrunk, according to private psychiatrist Tsoi Wing Foo, who co-wrote a book on transsexualism here with Singapore's pioneer sex-change surgeon, the late Dr S. S. Ratnam.
Since 1971, Dr Tsoi has seen over 2,000 transgender patients, half of whom go for surgery. A psychological assessment is needed before sexual reassignment here. During the 1970s and 1980s, he had roughly 30 cases a year. In the last seven years, he has seen an average of 40.
He does not know why surgery options here are dwindling, but speculated that it could be due to public policy changes or the personal preferences of the few doctors who have taken on such surgery. Dr C. Anandakumar, who had worked with his uncle, Dr Ratnam, declined to speak to The Sunday Times.
Dr Song of Cape Clinic specialises in female-to-male operations and had previously worked at the Singapore General Hospital.
A male-to- female operation at Cape costs $55,000, with the reverse being slightly more expensive, said Dr Song.
While NUH declined to reveal its most recent rates, such operations used to cost between $8,000 and $15,000 six years ago.
Dr Song said he has yet to see a patient for full reconstruction since setting up Cape.
Most seek partial reconstruction, such as removing breast tissue, as it changes the outward appearance and is more economical, he said.
The adjunct professor at the Duke-NUS Medical School, who has been performing sex- change surgery for two decades, said high facility costs is the main reason he cannot match the rates public hospitals used to offer.
Eight in 10 patients whom Dr Tsoi has referred for surgery choose to go to Thailand, "mainly because of costs". In Thailand, a full sex change costs around $20,000.
Those who go overseas for surgery may have to do without the immediate support of family and friends right after surgery, while cultural and language differences may affect the quality of post-operative care, said Oogachaga Counselling and Support deputy director Leow Yangfa. Oogachaga provides support for the lesbian, gay, bisexual and transgender group.
Mr Joe Wong, who underwent an operation in Bangkok to become a man, said doctors there were "only concerned about performing the surgery and provided little or no information on post- operative care and follow- up".
The 30-year-old said he knew the risks in having surgery overseas, but with scarce options in Singapore, he had little choice.