Yara would wake up every day to face the same agonizing question of what to wear. Unlike for many other women, however, this was not a question of picking between a dress, a skirt, or pants. For her, it was about dressing to avoid stares. Yara is a transgender woman in Egypt, and after years of hormonal treatment, she has been forced to live a double life, picking clothing to mask her transitioning body. “I wanted to avoid another beating,” Yara said, explaining how in 2009 a dozen men had surrounded and beat her based on her appearance. Two years later, she was beaten a second time, this time by state security forces.

Yara began her path to transition in 2012, when she was 21 years old, after years of feeling like she was living in the wrong body. Because of the general lack of awareness about gender dysphoria in Egypt, many transgender individuals only become aware of the possibility of transition in university or after. “The treatment journey may take up to seven years or more…every single step is with bumps and pits,” Yara said as she began her tale.

THE STRUGGLE FOR TREATMENT

Psychiatrists first prescribed for Yara antidepressants and mood stabilizers, which also suppressed her sexual drive. “It did not make sense; it was not about sex,” she said. She was also told to “turn back to God,” advice many doctors in Egypt give their transgender patients. The psychiatrist who first diagnosed her with a so-called gender identity disorder told her to live as a male among her family but as a female in more accepting circles.

But this would not work. Soon, Hashem Bahary, Egypt’s pioneering psychiatrist in transgender issues, came into the picture. “He was a haven for us,” Yara recalled, referring to a support group of transgender individuals Bahary brought together. Between a shortage of medical attention, family oppression, societal shunning, and political crackdown, transgender people in Egypt are normally forced to live hidden lives. “At first, patients thought they were alone in this world and were not aware that others suffer from the same disorder,” Bahary said.

Bahary heads the center for transgenderism at Al-Azhar University’s Al-Hussein Hospital, which follows international standards in treatment. Dubbed “the exclusionary disorder,” the doctor and his medical community, doctors must first eliminate the possibility of other disorders such as obsessive or delusional ideas to make sure the patient truly suffer from gender dysphoria and is not mistakenly seeking treatment for it, a standard practice in the rest of the world. The process requires two years of therapy and a minimum of six months of role-playing in the new gender to get a report acknowledging the gender dysphoria and the potential need for sexual reassignment surgery (SRS), an expensive procedure for most Egyptians that costs at least 20,000 Egyptian pounds, or approximately $1,100. At that point, some patients choose to undergo the surgery, while others don’t.

It is up to both Al-Azhar and the Egyptian Medical Syndicate, an officially recognized union that champions doctors’ rights and upholds their responsibilities, to issue official permits to conduct the surgery. The permits are needed mainly to deal with legal problems; if the surgery goes wrong and the patient does not have an official permit, he or she cannot file a case against the surgeon, Yara explained. Some doctors are willing to operate without the permits, but most refuse.

Yet the syndicate committee specializing in gender correction has not met in almost five years because one member, the member from Al-Azhar’s Dar Al-Ifta, is never present. The Al-Azhar hospital has also mostly refused to issue the permits. The refusal is either a direct one or an indirect one imposed through years of paperwork processing delays. “Al-Azhar denies patients an SRS permit, telling them that suffering is the will of God, and that they will have to deal with it for the rest of their lives,” said Heba, a transgender woman. Only ten percent of total cases received by Bahary’s center received approval from Al-Azhar. “There is no standard of evaluation; it is haphazard,” Bahary said.

When Yara decided to undergo SRS, she was unable to find any surgeon willing to operate with or without a permit until August 2016, when a doctor finally agreed to do it.

AN OFFICIAL CRACKDOWN

In some ways, the SRS is the least of an Egyptian transgender person’s problems. In Egypt, it is almost impossible for trans women to find a job. After working at her company for a year, Samar was forced to leave because some colleagues did not approve of the way she was beginning to look. “I fear the backlash. People here usually demonize people like myself,” she said.

In Egypt, it is almost impossible for trans women to find a job.

Late transitions make transgender people particularly prone to unemployment, according to Dalia Abdel Hameed, a gender rights officer at the Egyptian Initiative for Personal Rights, an NGO working to protect basic rights and freedoms in Egypt. Their physical appearance does not match official papers, which label trans women as males. Although it is technically possible to change one’s national ID, it is incredibly difficult. If just one official in the bureaucratic chain decides an individual doesn’t look traditionally masculine or feminine enough, that official can stop the paperwork from going through.

To make things worse, there has been a massive crackdown on gay men and transsexual women in Egypt since 2013, when military-backed President Abdel-Fattah el-Sisi took power. Raids on apartments and streetside arrests have become routine. More than 250 people have been detained. Abdel Hameed highlighted how the police set up accounts on dating apps and websites, invading them to find targets. “There is no specific reason for the crackdown, only speculations,” Yara said. One theory is that it is a way for the government to market itself locally by doing what the Muslim Brotherhood government of ousted President Mohammed Morsi refused to do. In that way, it glorifies the Ministry of Interior as the guardian of morality and religion. Another theory is that it is a conscious effort by the police to reestablish the power it lost following Egypt’s January 2011 revolution.

A more common speculation is that the crackdown is a good distraction. Because of bad economic and societal conditions, the government wants to gin up public outrage using sex scandals. “They are making people’s private sex choices the state’s concern,” Abdel Hameed lamented. Those arrested are charged with various degrees of debauchery, punishable by one to three years in prison.

Police detained Aisha, a friend of Yara’s, after raiding her apartment. She was placed several times in a men’s cell, beaten, and sexually harassed. Prison officers would sometimes wake her up in middle of the night and request that she show them her breasts. She was eventually acquitted of charges and released six months later. “She got off easy compared to others. Numerous transgender people were raped behind bars,” Yara said.

SOCIETY'S BIAS

Yara is among the lucky SRS recipients who has undergone the procedure with the support of family members, including her mother and boyfriend. Those who choose to be open about their surgery often face severe consequences.

When Samar told her parents, her freedoms were taken away. She couldn’t see any friends at home, was not allowed to go out without being completely monitored, and was interrogated upon returning home. “It’s a soul-crushing experience on so many levels,” she explained. “My father still believes that I was influenced by somebody, and he also believes that I am possessed by some fictitious devil. He tried taking me to a sheikh, but I totally refused,” she said. Using her chosen identity against her, Samar’s parents continue to refer to her using male pronouns and repeatedly remind her that she has no future and does not deserve a good life.

“To my father, I was the perfect son, the reliable man. Now I am a failure in his eyes,” she said. “Both he and my mother asked me, ‘Why would you want to be a woman? God blessed you by being a man.’” Samar’s parents see her as strong minded and generous, traits no woman can have in their eyes.

Some families force men who want to transition to marry, telling them that an active sexual life will make them forget the matter, Bahary observed. Yet the urge to transition to a woman doesn’t go away, and it persists once the individual has children. Children with two mothers would be shunned by society, so the transgender parent sacrifices to avoid putting the children in this dilemma. “They live miserably for the rest of their lives,” the doctor said.

Heba faces yet another issue in her homeland: relationships. Many men in Egypt are attracted to transgender women but fear the reaction of society and the people around them, she believes. Rather than pursuing relationships with transgender women, they have resorted to porn as the only outlet for this desire, taking whatever they see portrayed as reality. The first thing such men have typically asked Heba is “Are you a she-male?” When asking if what they mean is transgender, she has found they are not even familiar with the term.

Porn fetishizes transgenderism, Abdel Hady said, confirming Heba’s experiences of bad relationships. Rather than care about trans women’s lives outside the bedroom, many men approach such relationships to “try it as if we are a new McDonald’s sandwich to see whether they will like it,” as Heba put it.

HOPE FOR THE FUTURE

When it comes to changing attitudes toward the trans community or the LGBT community in general, Hady affirmed that it all boils down to education and awareness. Egyptian society still attaches a stigma to LGBT persons, viewing them as deviants and associating transgenderism with mental illness.

Yara’s experience drove her to become an activist for transgender issues. She formed a transgender community network, advocates transgender rights through her writing, and counsels others through the process. On March 31, 2016, which marks World Transgender Day, Yara came together with the Egyptian Initiative for Personal Rights to launch an online campaign called “See Me as I Am,” which highlighted misperceptions about transgender people. In March 2017, another campaign, “They Are Also Women,” exceeded expectations. “People’s reception and their willingness to acquire knowledge as opposed to rejection out of spite were remarkable,” said Abdel Hameed.

Portrayals of transgenderism in the media are often part of the problem. A hostess on a recent talk show, for example, screamed at her trans woman guest, “You are transsexual, you are not normal; how else do you want the world to see you?” addressing her using only her previous male name.

On a positive note, Abdel Hameed has noticed that more medical professionals are receiving transgender cases and becoming more sympathetic and more exposed to their condition in doing so.

“The first thing I want society to understand is that this is not a choice. Transitioning is a solution that takes time and effort and sacrificing important things in life like giving birth,” Yara concluded. Having had her life stopped until her physical and mental transitions were complete, she feels at peace today. “I can worry about normal things in life; I can study and work and make new friends.” She has yet to be recognized as female in the eyes of the government. But every day, she is able to wake up and pick an outfit, one in sync with her new body.