Last such surgery performed here in March

JOE, 27, seems to have it all - an engineering degree from Britain, a job that pays well, and a loving girlfriend of three years.

Many would say he's one lucky guy. Only thing is, Joe was not born a guy. But for the the past four years, he's been living as one.

His girlfriend knows his true identity, and accepts him for who he is. In fact, the two have even talked about getting married.

Joe was planning to go for a sex-change operation next year.

But his hopes were dashed recently when he found out that the National University Hospital (NUH) - the last hospital in Singapore to offer such operations - has stopped performing them.

''When I found out, I felt it was a disaster,'' he told Eyeball.

''Doing it in Singapore would have made the financial burden much lighter.''

He now has to go abroad for the surgery, which will cost more.

Sex-change operations in Singapore died a quiet death less than two months ago. Even the Ministry of Health (MOH) was in the dark.

In late March, NUH's Gender Identity Clinic closed its doors to transsexuals - people who want to surgically and legally change their sex.

According to a gynaecologist who used to work at NUH, the last sex-change operation was performed on March 20. He declined to be named or to furnish any details about the operation or the patient.

''It's a real pity,'' said the gynaecologist, who is now in private practice.

''After all, Singapore has been one of the leading centres for sex-change operations for the past 30 years.

''And now, literally overnight, it's all been disbanded. These people are Singaporeans. Why aren't we prepared to help them?''

NO SUPERVISOR

The inevitable question: Why did NUH stop such operations?

According to an NUH spokesman, it was done after the supervisor in charge of such operations left the hospital.

The spokesman added in an e-mail reply: ''We will be reviewing plans to decide when such operations can be resumed.''

However, the ex-NUH gynaecologist told Eyeball that the move to shut the clinic was in the pipeline even before the supervisor resigned.

''Some people were just not too receptive,'' he explained.

''Perhaps because many people have hang-ups about sex-change operations and transsexuals. Most hospitals aren't too keen to openly say that they do sex-change operations.''

To be fair, he admitted, the number of doctors here with the experience to perform such operations were few and far between.

Since Singapore's first sex-change operation in 1971 at Kandang Kerbau Hospital, there have been at most four doctors who performed such operations here.

Despite that, Singapore has earned a reputation as one of the top destinations for such procedures.

Perhaps best known is Prof S S Ratnam, a special consultant to NUH's obstetrics and gynaecology department. It is understood, however, that he has stopped performing such operations.

TABOO

Yes, the subject of sex change is still taboo. And not just among Singaporeans and hospitals, it seems.

In 1987, the Health Ministry told hospitals to stop performing the operations on foreigners. It also discouraged them on Singaporeans. At the time, such operations were available at NUH and Mount Elizabeth Hospital.

The reason: Sex-change operations are not life-saving procedures, and should therefore be given ''less priority''.

Also, the ministry had said then that these patients posed a higher risk of Aids.

Mount Elizabeth phased out sex-change operations about five years later in 1992, saying that it was because of the ambiguity surrounding the legal status of transsexuals here.

When asked to comment on NUH's latest decision to shut its Gender Identity Clinic, MOH replied that sex-change operations were legal in Singapore.

''Hence, hospitals have the discretion to decide if they want to perform such procedures,'' said a spokesman.

But that's scant comfort to Joe, who said: ''On the one hand, they allow transsexuals to get married. The operations are legal. But they deny us the chance to have the operations done here.''

Dr Tsoi Wing Foo, a consultant psychiatrist with NUH, who has seen many sex-change patients, and runs a private practice, agreed: ''It's a medical condition, and treatment should be available.

''It's not their fault...and they ought to be helped. People are generally prejudiced against transsexuals. In fact, they are mostly good and stable people.

''There's a lot of misconception.''

Dr Tsoi, who's been doing psychological assessments for transsexuals since 1973, told Eyeball that he has even written to NUH to appeal against the shutting of the clinic and for sex-change operations to continue. This was a month ago.

He's still waiting for a reply.

The ex-NUH gynaecologist suggested that instead of leaving the decision to individual hospitals, the Health Ministry ought to classify it as a medical condition and appoint a hospital to perform the operations.

''If they sit on the fence and not take strong decisions, you can't blame the hospitals. Nobody wants to take a stand,'' he said.

''It's not as if these transsexuals are asking for handouts. They save every cent they have for the operation. Now they have nowhere to go.''

But there are other factors to consider.

Dr Tan Chue Tin, a consultant psychiatrist at Mount Elizabeth, said: ''It's a very bloody operation, and you're dealing with genitals. There's a lot more risk involved, in terms of infections or complications.

''So hospitals may feel it's just not worth it.''

But he, too, feels that transsexuals - whom he says are in their predicament partly due to genetic influence - deserve more support.

DEMAND STILL THERE

In recent years, according to doctors, the number of female-to-male procedures have outnumbered male-to-female sex-change operations.

According to the ex-NUH gynaecologist: ''Females who want to become males started coming for treatment later. But, on the whole, the numbers for both types of procedures are about the same.''

Between 1971 and 1990, 413 such operations were done in Singapore, 282 of them changed sex from male to female, 131 from female to male.

All transsexuals have to have several sessions with at least one psychiatrist before any surgery is scheduled. The psychiatrist will assess if they really are transsexuals and are ready for a sex change.

Dr Tan from Mount Elizabeth said he used to see at least three transsexuals a month. He hasn't seen any for about a year now.

Dr Tsoi has seen about a thousand transsexuals in the last 30 years, and estimates that about 60 per cent went ahead with surgery.

Most were in their 20s, with males about 22 and females, 24.

But now, he sees about one transsexual patient a month.

The numbers are dipping, but not because there are fewer takers.

''I'm still getting calls almost every day,'' said the ex-NUH gynaecologist, who is in the midst of making plans to perform a sex-change operation on one of his patients in a hospital abroad.

GO ABROAD

Now that NUH has stopped performing sex-change operations, transsexuals have little choice but go abroad for the surgery.

Countries such as Australia, the US and France have reputable centres performing such procedures, but they cost much more than what it used to cost in Singapore.

In the US, male-to-female surgery costs about US$37,000 (S$67,000), while female-to-male surgery costs up to US$77,000. In Singapore, the operations cost between $10,000 to $20,000.

''Some of these centres are pretty good, but you have to pay a hell of a lot of money,'' said the ex-NUH gynaecologist.

''Thailand may be cheaper, but there is fear of complications and Aids.''

In Thailand, a male-to-female operation only costs $6,000, while a female-to-male operation would cost twice that.

But Joe would have much preferred to have the operation in Singapore.

He had chosen not to undergo the operation earlier because he wanted to gain his family's support and understanding first.

''I wanted them to be prepared for it. ''They are slowly accepting me for who I am...but now I have yet another problem. It's just not fair.''