Changing your gender in South Africa

“But especially when you start reaching puberty, the expectations of which gender you should be and the strength of which gender you are assigned means that you have more people wanting you to conform to that,” she says.

Defining “transgender” is difficult because its definition is continuously evolving says Busisiwe Deyi, the legal research coordinator at Gender DynamiX, an organisation that focusses on the transgender community. “What I like to say is that [transgender people] are people whose gender is not in line with society’s assumptions about their sex,” says Deyi.

Accessing adequate and sensitised healthcare services is often difficult for transgender people due to the multiple levels of discrimination and the numerous obstacles they often face when visiting a healthcare facility.

“Two years ago, at the beginning of 2013, I was diagnosed with chronic kidney failure. That required immediate and urgent specialist medical care in order for me to actually survive. So it has been a long journey within the medical world and a deep engagement with medicine and doctors and nursing staff over the last two years,” says Ndelu.

“I had my kidney transplant at the end of last year and they [the doctors] always have to give an introduction [of the patient when they do ward rounds] and when one doctor was introducing me he kept referring in brackets to ‘transgender issues’. … Even referring to it as an issue was quite antagonistic towards me,” says Ndelu.

After her transplant, Ndelu had a few complications and another doctor who was deliberating on what to do said, “You know we [the doctors] should also consider that this is actually a man,” and laughed in front of her. “Of course in terms of my biology, it is an important consideration, certain patterns happen to certain bodies, but perhaps that could have been handled in a more sensitised way,” says Ndelu.

Ronald Addinall, who is a clinical social worker, sexologist and lecturer at UCT, is part of the team of medical professionals that run the Transgender Clinic at Groote Schuur Hospital, the only clinic of its level of expertise in the country, if not the whole of Africa. Addinall says that there have been changes in standards of care for transgender people and transgender people are also recognised by South African legislation. “But on the day to day reality and lived experience, that hasn’t necessarily translated for them,” he says.

Ronald Addinall. Photo by Ashleigh Furlong.

If transgender individuals wishs to make not only a social transition, but also a hormonal and possibly a surgical transition to align their sex characteristics with their gender identity, they need to be diagnosed with “gender dysphoria”. This is when people’s gender identity does not match their sex assigned at birth and therefore causes them distress.

“Yes, hormones are an important element to some and surgery is an important element to some but often what happens is that one gets caught up in just that – getting hormones and surgery. There is a lot more in terms of a holistic healthcare point of view and services that the transgender community needs,” says Addinall.

Gender identity begins to form at a young age as Ndelu’s story shows. Addinall has even begun to work with children who identify as transgender, the youngest being a Grade 2 learner.

“Certain children will play, explore, experiment, and then you get the children who are persistently, consistently and insistently stating that they are not the gender that society is saying that they are and they become distressed, they become distraught, and that has been observed for a significant period of time. That would distinguish the transgender child from the mother who phones me saying, ‘My little boy was wearing my high heels walking down the passage, does this mean he is trans?’ ” explains Addinall.

Once young people turn 18 they can begin the process of transitioning, but this is not always easy. The only public facility that offers a consistent and reliable programme is the Groote Schuur unit. The Steve Biko Academic Hospital in Pretoria also offers gender alignment surgery but transgender advocates say that the unit is not as good as Groote Schuur’s.

Accessing hormones is relatively simple but accessing surgical treatment will mean a wait of between 21 to 27 years at Groote Schuur, if the current rate of four surgeries a year continues. This number is based on a formula that the hospital uses to allocate theatre time.

Currently only one medical aid, Bankmed, has paid for any surgeries, meaning that even if patients have medical aid they will probably need to pay out of their own pocket, or prepare themselves for the long wait at Groote Schuur. Deyi says that the private route is prohibitively expensive and most surgeons don’t have the expertise, so many patients go overseas for the surgery, where it is cheaper and more surgeons are skilled in practices such as colon grafting and creating vaginal canals.

Many transgender people also struggle to find work, especially when their identity documents and the gender that they present do not match up. Altering one’s sex description on an ID is provided for by the 2003 Alteration of Sex Description Act. The Act says that “any person whose sexual characteristics have been altered by surgical or medical treatment or by evolvement through natural development resulting in gender reassignment, or any person who is intersexed” may apply for sex description to be altered on the birth register.

But this is often a difficult process. Deyi says that even though the Act doesn’t require surgical intervention, meaning that hormonal treatment is sufficient, many clerks at Home Affairs offices will turn people away who have not had surgery due to the clerks’ incorrect interpretation of the Act.

Deyi is aware of a person who has been waiting for seven years for an ID alteration. One of the problems with this is that the person cannot leave the country to receive gender alignment surgery because of of the difference between their identity document and their gender presentation.

“Government can’t provide the health-care, but when you do try and access it, they prevent you,” says Deyi.

“In a perfect world I would like the ID to have either a third gender like X or just blank, I don’t see why we need to have that as an identifier,” she says.

Ndelu, who has yet to change her ID, says when she was trying to get a cellphone contract the store assistant put her ID number and her gender representation into the system but the programme refused to accept the incongruence.

“If my ID document and if my name is gendered in a certain way, I want to … disrupt space, to make things not normal, to look at the shop attendant while I am trying to get a contract and say, ‘I am a transwoman’. And look him in the eye for that and disrupt the everyday erasure and invisibility of transbodies.”

Places where transgender people are made to feel welcome and where their concerns are vocalised are often scarce. One such space that provides an advocacy, educational and community role is the TransCollective at UCT, of which Ndelu is a founding member. Ndelu says that UCT purports to be a certain type of institution and the TransCollective is here to “call them out” when they believe that the university is not living up to their standards. “We have passed the state of negotiation and debate, we actually are saying that this is what people need, so do it.”

Ndelu believes change in South African society is not happening as fast as it should. She says that in many ways UCT is just a reproduction of the rest of the country. “Decisions about changing attitudes, decisions about active measures to start changing the fabric of society are taken by people who aren’t even affected by these issues,” she says. “When people like me raise their voices, when people like me protest, when people like me ask the institutions to see us, and make provisions for us – the institutions don’t listen. How can we think that they are serious about creating change within this institution and within the broader South Africa when they can’t even listen?”