MUMBAI: Sukanyeah Krishna and Aarav Appukuttan became an overnight internet sensation when they spoke about their unique love story that blossomed in a sex change clinic in Mumbai but the response to a crowdfunding plea for their sex-change operations has been sluggish. Millions read about Chandhu transforming into Sukanyeah, and Bindu turning into Aarav, but only eight people were moved to contribute Rs 4,400 towards Sukanyeah’s goal of Rs 6 lakh.So, while India emerges as a medical tourism destination for affordable gender reassignment surgery , it is perhaps not a happy place for many who make the change. Sunita (name changed), a Mumbai suburban youngster, agrees. She sees many who underwent reassignment surgery along with her three years ago at traffic junctions to “pick up clients”. “Acceptance is not easy. Families seek to cut you out of their lives as well as property,” she added.In 2012, Assamese youngster Bidhan Baruah moved Bombay high court against his parents for preventing him from undergoing a sex change operation. Five years later, as Sukhanyeah wrote on her Facebook page last week, there has been a “mixed reaction” to their gender reassignment surgery. At least one man wrote a death threat on her page.The sense of alienation that transsexuals feel holds true across the world. The only long-term study that traced the lives of over 324 people in Sweden who had gender reassignment surgery found a higher suicide rate and depression in comparison to others.“Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population,” found the Swedish study conducted between 1973 and 2003. Published in the PLOS-One journal, the study said sex reassignment alleviates gender dysphoria but may not suffice as treatment for transsexualism, and should have better psychiatric and somatic care.In Mumbai, Dipika (name changed) is the toast of her circles for her “model” transition. She, however, concedes that none of her boyfriends in the last five years know she was previously known as Sanjay. Although gender reassignment surgery entails making external sex organs, patients can never have children. Dipika confesses she buys sanitary napkins and pretends to her boyfriend she has monthly periods. “I love children, and I am terrified to tell my boyfriend that I can never have any of my own,” she said.Plastic surgeon Dr Anil Tibrewala said there is a lot to manage after a sex-change operation. “Unlike a rhinoplasty or facelift that can achieve perfect results, gender reassignment leaves a lot of scars. People need a lot of support, which is not easy to find.”Dr Sanjay Pandey, a urologist who runs one of the busiest gender reassignment clinics here, refuses to take a dismal view. “The views to my tutorial on YouTube increase by two to three digits every day. The number of people who call me up for gender reassignment surgery has gone up sharply in recent years,” he said. Moreover, he has a number of happy stories to share. Apart from Sukanyeah and Aarav, he speaks about a male-to-female patient leading a fulfilled married life in Rajasthan.A government official walked into his clinic at Kokilaben Ambani Hospital in Andheri last year, seeking reassignment surgery for his daughter. “He said his daughter had one dream to urinate while standing, and he and his wife helped their daughter throughout the transition phase. Clearly, parental support is growing for patients,” added Dr Pandey.Aarav, who was a female for 43 years before starting the gender reassignment process three years ago, is hopeful. He will be happier if India pitches in for Sukhanyeah’s last operation. “The operations are expensive, and are likely to cost Rs 6 lakh. As soon as the operation is done, we plan a September wedding.”