Fifty-four-year old British national Sue Pascoe can never forget her trip to India in March. It was here at Olmec Plastic Surgery Centre in Delhi's Pitampura that she was given the body she always craved – of a woman. Born Graham Pascoe, she had gender identity disorder or gender dysphoria, which made her feel at odds with the gender she was born with and led her to identify instead with the opposite gender.

It was in August 2014 that she got an official diagnosis but the earliest she could have undergone sex reassignment surgery (SRS) under UK’s perennially overbooked National Health Service was four years later. But after pretending to be someone else for half a century, Pascoe didn’t want to waste a single day. Private treatment would have set her back by £40,000 (about Rs 40 lakh), so she started scouring the internet for alternatives.

While Thailand -- the global sex change capital – was an option, she finally chose Delhi over it. “I wanted affordable quality care from a highly experienced surgeon with high patient satisfaction from reference-able clients. What also attracted me to India was the fact that it is home to such a huge population of trans people,” says Pascoe who gleaned all this information online. She was operated upon by Dr Narendra Kaushik.

Like Pascoe, more transgenders are choosing India as a destination for SRS. The procedure costs between Rs 7.5 lakh and 11 lakh in Thailand whereas in India you can get a new sexual identity starting Rs 3.5 lakh without compromising on the quality of treatment.

As for Pascoe, she underwent two surgeries – one in December 2014, the other in March 2015, which cost around £9,000 or Rs 9 lakh – and she transitioned from Graham to Sue. Flush with hormones and a new curvy figure, Pascoe went sari shopping in Delhi and wore a black and gold number with a backless blouse on her flight back home “I got so many compliments for it but it became a bit of a bother when I landed in Manchester and there was snow on the ground,” recalls Pascoe in her surgically modulated feminine voice.

Thirty-three-year-old Ikram from Kenya wanted to undergo male-to-female SRS in Serbia , which in recent years has emerged as a hub for gender reassignment in Europe. “The surgeon I contacted in Serbia asked me to go to India instead as it has cheap but skilled surgeons,” says Ikram who hails from a family of farmers from a coastal town in Kenya. Ikram underwent genital reconstruction in Delhi in January this year and will return in six months for breast augmentation. Transgender tourists are now adding to India’s booming medical tourism market, which is expected to attract 320 million tourists this year, according to a KPMG-FICCI study.

Dr Parag Telang, a plastic surgeon in Mumbai, counts eight foreigners in the last year. “Four were from Denmark, two from the UK and two from South Africa,” reveals Telang, adding that foreigners also come to his clinic for facial feminization surgery. It is a highly skilled set of procedures that involves restructuring the face to look more feminine. This includes a nose job, lip augmentation, cheek implantation and brow lift. “Most SRS procedures are male-to-female,” says Dr R K Mishra, a plastic surgeon in Lucknow, who has operated on eight foreigners in the last year, from New Zealand, Sri Lanka and Thailand.

At Olmec Centre, plastic surgeon Dr Narendra Kaushik has operated on 15 foreign patients, including Pascoe, in the last one year. “Most were from Australia and New Zealand, but also Nigeria, South Africa, Afghanistan and Thailand,” says Kaushik.

Tourist-friendly Thailand, with its trans-friendly policies and numerous JCI-accredited medical institutions (Joint Commission International is a patient safety accreditation organization), still commands a lion’s share of global sex-change procedures. Preecha Aesthetic Institute, a key player in this market, claims to have carried out more than 4,000 male-to-female surgeries in 30 years.

While India is no competition to Thailand yet, it is getting noticed. Although there are no official estimates on the numbers of foreigners who’ve undergone sex change in India, surgeons TOI spoke to are clearly seeing an upsurge. “Patients who get operated here spread the word on online forums and this draws more patients to us,” says Dr Sanjay Pandey, urology and transplant surgeon at Kokilaben Dhirubai Ambani hospital, which has a separate team for gender reassignment headed by Pandey. Pascoe herself has been recommending India to her transgender friends.