The term SRS is no longer used. The correct term would be Gender Affirmative Surgical Care. It includes a number of surgical interventions carried out by a Gender Affirmative Care Team (GACT) to align the body of the individuals with their perceived gender in order to reduce dysphoria. (The list of surgical interventions can be obtained from https://www.wpath.org/soc8)

The degree and type of intervention to be undertaken by the team is decided by the individual using an informed consent approach wherein the pros and cons of the intervention, complication rate of the procedure, results of surgical interventions carried out at the centre, preoperative preparations, aftercare required, and experience of the operating team is discussed with the individual and their decision is recorded.

Since surgical interventions are difficult to reverse and lead to more or less permanent changes, it becomes very important, and is ethically and legally binding that the individual be capable of making a decision and understand the implications thereof. Hence a letter of recommendation is sought by the GACT from the mental health provider stating the above and reassuring the surgical team of continued mental health support during the pre-operative, operative and post-operative period.

Furthermore, due to the complex nature of the surgeries, the individual requires prolonged periods of social and financial support till the healing is complete, and the person becomes well adjusted. Hence this too needs to be in place before the intervention is undertaken.

The degree and type of aftercare needed varies in accordance to the intervention undertaken, and may range from six to eight weeks to lifelong care.

In the public sector, of note is the All India Institute of Medical Sciences, New Delhi, which has started the Centre of Excellence for Transgender Care and is providing holistic transgender healthcare including Gender Affirmative Surgical Care to transgender and gender diverse individuals.

In the private sector, most multi-speciality tertiary care hospitals in the metropolitan cities offer Gender Affirmative Surgical Care. However, by and large the transgender healthcare delivery remains costly, unregulated and disorganised, there being no or very poor teamwork, aftercare and follow up.

The decision to change one’s gender is personal, and it is a celebration of one’s own sexuality. It also comes with a slew of legal procedures to ensure that the new identity is documented correctly and on time.

Birth certificate, Aadhar and passport, bank records, house rent/ lease agreements, and all other means of identity proof should carry the new gender once your transformation process is over.

The legal procedures start with the preparation of an affidavit that declares the change of gender, the new gender and name. The Department of Publication has prescribed a format for the affidavit, and it should be adhered to. It asks for all personal details – name, gender, address, father’s name etc. This affidavit should be printed on a stamp paper and attested by a notary.

The next step is to publish an advertisement in a newspaper – regional or national. It should have the details given in the affidavit, stating your change of gender.

Once this advertisement is published, it is the turn of the notification in the Gazette, the official magazine of state and central governments. (https://deptpub.nic.in)

A duly signed application with all relevant documents has to be filed with a prescribed fee.

Documents required for application:

• Self-attested copies of ID proof (Aadhar/Voter ID/Passport)
• Two self-attested passport size photographs
• A newspaper publication carrying the details of the gender change
• A specimen proforma signed by the applicant and two major witnesses.
• A declaration stating that the contents in the application are true.
• A letter of request to the authority with the mandatory fee.

It usually takes 45 to 60 days for the department to review the application and publish it in the gazette. If the application is rejected for any reason, a new one has to be filed. The gazette is usually published every Saturday, and it can be downloaded from the official website. A copy of the gazette is also sent to the applicant as email. This notification acts as the proof of gender change, and it needs to be kept safe as it is required for making changes in all documents including Aadhar, PAN card, Voter’s ID and others.

The Aadhaar can be updated through the Self Service Update Portal— ssup.uidai.gov.in/ssup/ with OTP-based login.There is a limit on these updates; a name can be changed twice in lifetime while gender and date of birth can be corrected only once. If the person needs to change the photo, he/ she/ they should visit the nearest Aadhaar Enrolment/Update Centre.

To change the details in the passport, an application accompanied by necessary documents should be submitted. A fee needs to be be paid for re-issuing the passport, and the applicant should make an appointment with the Regional Passport Office or Passport Seva Kendra to get the documents and biometrics verified. Once the application is approved, the new passport will reach the applicant within days.

The process to change gender in a Birth Certificate might vary according to the location of the individual. Some states provide transgender people the option to get a self-declaration certificate to change their name and gender on official records. In most states, the application needs to be submitted at the corresponding municipal office along with supporting proof and fee.

Once the official documents are corrected, one should also get the details changed in other records like those of bank accounts, insurance and investment certificates, and property agreements.