Surgery not only choice for trans people

“28 days after that, I transformed into a woman,” said the Hanoian trans woman, who now works as a barista at a cafe on Nha Tho street, Hoan Kiem district.

Tien said she only realised that she identified as a woman two years ago. Yet her desire to “be a complete woman” was so strong, it took her to the operating room.

It was not long after the surgery that Tien started encountering the challenges present in a woman’s life. She had to familiarize herself with female body parts after living in a male body for 20 years. Every day, it takes her about one hour to take care of her new body. Her breasts are now a disadvantage when she runs. Every time she wants to go for a run, she must first spend 15 minutes covering her breasts in fabrics. Despite that, she still often feels insecure

Huynh Tien heading towards the finish line of a marathon in 2021. Photo courtesy of Huynh Tien

Thuy Tien, who comes from Hai Duong and is now 22 years old, is a bit more fortunate. After completing a breast construction surgery in Thailand, she was planning to come back for an additional vaginoplasty (surgery in which a vagina is constructed). However, before the trip, she had a moment of enlightenment when she talked to a friend.

“How do you feel after undergoing vaginoplasty?” Thuy Tien asked Truong Kim Kim, a trans woman who constructed her breasts in 2016. At that time, Thuy Tien assumed that Kim had surgeons fix her whole body, because she always appeared confident and gorgeous.

Responding to Tien’s question, Kim said she didn’t think she had to re-construct every part of her body in order to acquire a happy life and a male lover. She did not have any plans to change her genitals. She said that being accepted as a woman and having a higher chance of marrying a man were not her main purpose in life. After the conversation, Thuy Tien cancelled her trip to Thailand.

Thuy Tien and Huynh Tien are only two among around 480,000 trans people living in Vietnam, according to Ministry of Health estimates. This term was coined to describe those who gender identities differently than the sex assigned to them at birth

Thuy Tien not long after her breast construction surgery at the beginning of 2022. Photo courtesy of Thuy Tien

Ngo Hoang Ngoc Hiep, a researcher working at the Institute for Social, Economic, and Environmental Research (iSEE), a Vietnamese non-governmental organisation supporting the rights of the marginalised social groups, said that many trans people assume that going under the knife is necessary. The assumption comes from the fact that failing to live in a desired body could generate the feeling of “gender irritation.” This, in turn, contributes to mental pressure.

In one iSEE research study about trans people’s experiences of and needs for gender-affirmation operations in 2018, iSEE stated that 94% of the surveyed trans women and 68% of the surveyed trans men reported experiencing this irritated feeling. In addition to that, 89% of the trans participants were aware of a mismatch between their desired genders and current bodies, while 66% didn’t feel confident about their look. These were the biggest reasons for them to undergo gender-affirmation surgeries.

However, going under the knife doesn’t guarantee satisfaction afterwards. Cases like Huynh Tien are not rare. Professor Tran Thiet Son, former Head of the Department of Plastic Surgery at Hanoi Medical University and one of the top specialists in the field, observed that the more surgeries someone undergoes, the higher chance they have of experiencing dissatisfaction. More often than not, those who undergo genital reconstruction surgeries are not satisfied with their new genitals. “There are many reasons for a genioplasty to go wrong. The fact that not all cases are perfectly done, the high complication rate of the procedure, having to take care of and observe the states of the new body part, even having to re-operate sometimes, especially in trans women, all contribute. There are even lifelong complications,” Son stated.

To avoid this, the specialist advised those planning to go under the knife to get psychological consultations first. At the same time, prospective patients are encouraged to speak with those who have already completed such procedures to ask questions about the experience. Once the surgery has been done, it is almost impossible to go back. Thus, spending time contemplating comprehensively beforehand is never a waste.

In fact, laws in many countries acknowledge that anyone identifying differently than the gender they were assigned at birth – operation or not – is a trans person.

Truong Kim Kim gave another insight that as far as she knew, 90% of the American trans community didn’t go under any operations, because they prioritised their own happiness and physical health. Surgeries do not necessarily contribute to achieving these.

Currently, Huynh Tien is planning to re-operate her breasts to reduce their size, for the sake of running. “Only after the surgery did I realise full operation was not necessary. For people whose only purpose is having their appearances match their gender identities, partly changing their body is already enough,” she said.

Regarding Thuy Tien, she is currently satisfied with her body and does not want to go through any additional genital surgeries. She made it clear to herself that she would only go for this kind of operation if she redevelops the thought of doing so before she reaches 30. After that age, she will drop this idea to protect her health.

The conversation last summer also motivated Thuy Tien to become a public speaker. She has given presentations at different schools and workplaces discussing the topic “Our bodies, our choices.”

“Every trans person can freely decide whether they want to live with their given biological bodies, regular hormone infections, or gender-affirmation surgeries, without being affected by prejudices or discriminations,” she said.