Originally, sex change operations in Singapore involved only hermaphrodites (people with both male and female genitalia) and the removal of one set of genitalia.

That changed in 1971, when the first sex reassignment operation was successfully performed on a Singaporean male in Kandang Kerbau Hospital (KKH), paving the way for Singapore to become the leader in sex reassignment surgeries in the 80s.

It was also the first of its kind in Asia.

The operation was carried out by Professor S.S. Ratnam and two other surgeons from the University of Singapore’s Department of Obstetrics and Gynaecology (O&G).

The male-to-female operation involved a three-hour surgical conversion to functionally change the patient's sex and appearance.

The process leading up to surgery

The patient was a 24 year old Chinese Singaporean when she underwent surgery.

In her teenage years, she started cross-dressing and living as a woman. In 1969, she consulted with Professor S.S. Ratnam and told him she wanted a sex change.

A thorough psychological analysis was done by a team of psychiatrists to evaluate the patient. Some of the considerations included:

-Does the patient have a desire to remove his/her genitalia and live as the opposite sex?

-Does the patient have a continuous sense of inappropriateness about the sex he/she was born with?

-Is the gender confusion caused by other mental disorders (e.g. schizophrenia)?

Medical experts also discussed the case at length. The team concluded that the patient required surgery.

Legal clearance for the operation was sought from and subsequently granted by the Ministry of Health.

Post-op: Legal implications up to 1997

As of 1973, transsexual individuals are able to change their sex recorded on their IC. Between 1980 and 1985, a total of 99 people underwent sex change and had their new particulars recorded on their IC.

However, there were still legal challenges ahead for these patients who had undergone a sex change.

Before 1991, marriages involving a transsexual individual were implicitly recognised because one only needed to produce their IC to register their marriage.

However, in 1991, a marriage between a transsexual man and a woman was voided by the High Court, making such marriages illegal. Couples getting married then had to present their birth certificates instead.

It was only in 1996 that there was amendment in the Women's Charter, allowing transsexuals to marry legally with effect from 1 May 1997.

As long as both parties could prove they were of the opposite sex by showing their ICs, they would be allowed to wed.

The road ahead

The 1971 operation paved the way for future sex reassignment operations and Singapore, in the 80s, became the go-to place for such operations.

However, since the late twentieth century, the number of surgeries performed in Singapore has gradually dwindled, possibly due to the high costs of doing the surgery locally.

As of 2014, a male-to- female operation performed in a private hospital could cost around $55,000. Sex change operations in public hospitals ceased in 2013. Many patients consider Thailand a more affordable option, with a full sex change costing only around $20,000.

Even though the possibility of sex change operations and hormone replacement therapy provide some hope to people whose gender identity does not conform to their sex, there are still challenges ahead.

Transsexual and transgender individuals still face social stigma and discrimination. They are often dismissed by their family, and homeless transgender individuals sometimes have no where to turn to - they cannot go shelters for either women or men.

Aware of this problem, June Chua founded the The T Project as the first transgender shelter in Singapore aiming to support and provide a positive impact on the transgender community.

When was asked about her ultimate wish for the shelter, she said that she hoped it would one day be redundant. "That would mean transgenders now have a place in society, are independent, and no longer discriminated."

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Top photo via Getty Images

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