It is a beautiful morning, just before nine a.m. The sun shines in a cloudless sky. Lilith is standing with her suitcase on a platform in the Cologne train station as two little boys play nearby. She likes children and hopes to have a family of her own someday.

Lilith is on her way to the Essen University Hospital, where in 24 hours she will be on the operating table for another abdominal surgery. This time, it is for cosmetic corrections following the seven-hour gender confirmation procedure she underwent a few months ago, in which the doctors formed a vagina from her former scrotum and penis.

Lilith takes pride in her appearance. Today, she is wearing a blue summer dress and is perfectly made up. "I'm very excited," she admits, as the train pulls into the station. The hourlong ride from Cologne to the Ruhr-area city of Essen is the end of her long journey, which began 33 years ago in Pakistan as Ali.

In this photo Lilith still appears as the male-bodied Ali

A meaningful ritual

For more than three years, Deutsche Welle has been reporting on Lilith and her story. When we first met her in the spring of 2016, she was physically still a man. She was not yet taking female hormones and testosterone blockers on a daily basis, and she looked significantly less feminine.

She went by the name Alia then. With the addition of a single vowel at the end of her male birth name, she had given herself a female name. At some point, however, she decided that she wanted to completely break away from Ali, the person. Since then she has gone by Lilith. "Lilith, the woman who was always there," as she put it.

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Lilith is an open person. She speaks freely about her trans identity. It was only on the eve of her first major surgery, in February 2019, that she chose not to talk to anyone. "I deliberately wanted to say goodbye. It was like a ritual for me. I said goodbye to my old body and welcomed my new one."

Her last hours with Ali were a happy goodbye, she recalls. "It will always be part of my life. But Ali was like a shell; he just was not the right person."

Pakistan: Where being trans is taboo

As a small child, Lilith already knew that she could not be Ali. Nature simply made a mistake when it gave her this male body, she says. But that was a dangerous realization in her South Asian homeland.

Society in Pakistan is very conservative and patriarchal. The country is an Islamic republic, and many inhabitants are deeply religious. In this environment, topics such as homosexuality or transgender identities are largely taboo.

Visibility of trans individuals often comes through the historical tradition of hijra or kinnar, transgender people who tend to serve a social function. Today, they are frequently booked as dance performers at wedding celebrations.

But that visibility cannot hide the fact that most transgender individuals in Pakistan lead a life on the margins of society. They are also repeatedly victims of violence and even murder. In its World Report 2019, Human Rights Watch wrote that last year alone there were nearly 500 attacks on trans women in the Pakistani province of Khyber-Pakhunkhwa, on the Afghan border. At least four of those individuals were killed.

Dancing despite fear - Pakistan's cross-dressing men Dancer by night When night falls in the city of Rawalpindi, Waseem starts to dance. The 27-year-old acts as a "hijra," the third gender. Estimates suggest thousands of them live in Pakistan. They are especially popular as dancers at weddings or baby showers because their prayers are deemed very effective. However, these are the only occasions they are truly accepted.

Dancing despite fear - Pakistan's cross-dressing men Different in daylight During the day, Waseem sells cell phone accessories in an alleyway shop. His colleagues or friends know next to nothing about his nightly life.

Dancing despite fear - Pakistan's cross-dressing men Turning into Rani, the dancer For Waseem, leading this double life serves mainly as a way to achieve a better life: "Being a dancer helps me to earn much more money than working in a shop," he says. For true hijras, life is a constant fight. Those who can't work as dancers, in many cases drift off into prostitution. All of them - even Waseem - face harassment and abuse.

Dancing despite fear - Pakistan's cross-dressing men United in loneliness Many orthodox believers hate these "creatures between men and women". Radical Islamists attack them in public. That's why the hijras shy away and live in a close-knit community. "Eyes follow me when I walk out of the apartment," says 43-year-old Bakhtawar. "Being with other dancers is like being with a family. When I am surrounded by them, I feel safe, respected and empowered."

Dancing despite fear - Pakistan's cross-dressing men Showing their true selves Many hijras fled from these stares to the anonymity of a big city, keeping their true self from colleagues or family. However, Pakistani law is rather progressive in this regard: In 2011, a Supreme Court ruling officially recognized the third gender. Hijras can now tick it off in their passports, are allowed to vote, open a bank account and work legally - helping some get away from prostitution.

Dancing despite fear - Pakistan's cross-dressing men Standing up for equality For the first time, transgender people like Bindiya Rana (pictured on the right) ran for the country's parliament during elections held in 2013. Although she didn't get into parliament, she has kept fighting for equality and an end to discrimination. New laws have so far not succeeded in bringing any major change to the public mindset in the conservative Pakistani society.

Dancing despite fear - Pakistan's cross-dressing men Living a double life Even today, only few transgenders are openly presenting their identity with such pride as Amjad. "The only thing that I can't do is conceive babies," the 44-year-old says. Author: Monika Griebeler



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Even the families of many transgender women reject them due to an overwhelming sense of shame. Lilith was very lucky. She was supported by the two people closest to her, her mother and sister.

In Lahore, Pakistan's second-largest city, they shared their lives and day-to-day with Lilith when she still outwardly appeared as Ali. Throughout her youth she wanted to wear girls' clothes and makeup at home. She felt she was a daughter and sister, not a son and brother, despite having to present herself as male to the world and hide her true self.

A fresh start in Europe

Lilith has been living in Germany since 2012, when she arrived in the country for her studies. She dreamt that in Germany, she would finally be able to openly live out her sexuality, dress as a woman, have an everyday public life as a woman. Over the next three years, she came to the decision to undergo gender confirmation surgery.

Lilith studied environmental science in Cologne and graduated with a Master's degree two years ago. She has come to feel "at home here," she says in fluent German on the train to Essen. It took a few years, but now she feels she has completely arrived.

Lilith does not yet have German citizenship, but she intends to submit her application in the coming year. At the moment, her residence permit is tied to her job. Lilith works for the Lesbian and Gay Federation of Germany, where she looks after homosexual and transgender refugees.

It took time for Lilith to feel fully comfortable in her new female body

Lilith's mother paid for Lilith's first flight to Germany by selling a piece of land she owned. In each of our interviews, Lilith has spoken of her mother with love and gratitude. But now, just before her second surgery for gender confirmation, her voice carries a sad undertone.

Though Lilith's mother never objected to her child who was born physically male but desired to live as a female, she finds it difficult to understand this final step. "The operation finally makes it clear to my mom that she now has another daughter and no son anymore. That it cannot be reversed. And despite everything that is difficult for her to accept," Lilith says.

Lilith finds this difficult, but she also tries to empathize with her mother. "She just cannot understand the dissatisfaction, the hate I had for my own body." Nevertheless, the two still have daily contact. Lilith also often speaks to her sister, who had no problem with the physical change. "For her I'm just her sibling, no matter if a brother or a sister."

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Gender surgery on the rise in Germany

One day after the first major operation, on February 19, Lilith posted on Facebook: "I cannot describe this feeling. I just truly feel like Lilith."

It was a major moment when she finally saw her own body match her inner identity as a woman. "A doctor held up a mirror for me, and I just cried for joy." For Lilith, gender confirmation means finally having achieved what she always wanted.

Lilith posted on Facebook in February 2019 while she was in the hospital

German health insurance companies bear the costs of a gender confirmation for those insured by them, but every single case is reviewed. Lillith is one of a total of 45 trans women who were operated on during the first half of 2019 at Essen University Hospital. Demand is rising, the hospital management told DW. In 2014, 50 trans women were operated on; in both 2017 and 2018 that figure was around 80.

Nationwide, more than 600 people assigned male at birth underwent gender confirmation surgery in 2018, the German Ministry of Family Affairs reported in response to a DW request. Conversely, more than 1,200 people assigned female at birth underwent gender confirmation procedures over the same timeframe.

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Physical and mental stress

Some patients continue to struggle with their identity after the operation. But Lilith is confident in her decision and would do it again despite the difficulties of the process: the daily hormones she had to take; the numerous visits to the doctor; the obligatory psychiatric examinations; a bureaucratic marathon with the health insurance until treatment was finally approved; and then the extreme pain after the first operation.

During the male-to-female gender confirmation surgery, physicians form a neovagina from the inverted skin of the penis and the former scrotum. The clitoris is formed from the glans; the labia from the foreskin.

For weeks, Lilith could neither walk nor sit properly, or even lie down without pain. She could barely even think about sleeping. "It's like hundreds of little needles that are electrified and dancing to techno music," she describes it.

There was also inflammation in her new vagina, and she had to go back to the hospital for a week. "At some point you are just very weak, not only physically, but also mentally." And as much as she had always wanted her new, feminine body, at first it still felt strange — not quite part of her. "I could not touch myself, either. My brain was totally confused."

Exploring home and identity

Then, after about six weeks, things suddenly clicked. "The brain suddenly tried to associate the body parts. The old parts have all been rebuilt, in a way," she explains.

Everything goes according to plan at Lilith's second, cosmetic operation in Essen. She returned to work a while ago and has readjusted to being back in her everyday life, though it is somewhat different than before. She puts it this way: "In the past, my soul and my body were separate. The soul has always tried to find the right body."

Read more: In much of Asia, transgender people 'not even considered humans'

Lilith, who attended LGBT+ pride demonstrations in the past (above), now feels her body and her soul are united

Yet a yearning remains. Lilith would like to travel back to her homeland of Pakistan someday. She misses her family, she says. She misses the Himalaya mountains. She wants to once again hear her mother tongue Punjabi on the street and taste the food of her childhood. But as a trans woman and as an avowed atheist, the trip would be far too dangerous at the moment, she says: "A 'lower being' like me has no way of living in Pakistani society."

However, she will soon meet her mother and sister "on neutral ground, somewhere in the world where men and women are equally worthy." For security reasons, she does not say where exactly they will meet.

She sees her future in Germany, but her identity is more than a nationality, she says. "I do not feel like a German or a Pakistani," says Lilith. She just feels like a woman, like a human.

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