Past

South Africa under Apartheid was a more complex beast than one might imagine when it comes to issues of gender identity. Although homosexuality was a no-no, there was a surprising amount of activity occurring under the radar – and, say activists, there was a lot more medical expertise regarding gender reassignment surgery than one might expect.

Busiswe Deyi, research co-ordinator at GenderDynamix, told Daily Maverick, “You find South African doctors who are 70 or 80 and know everything and do everything. But suddenly we don’t have the expertise? South Africa [at one stage] was leading gender reassignment surgery.”

GenderDynamix pointed Daily Maverick in the direction of the aVersion Project, an independent study of human rights abuses on homosexuals in the military under Apartheid. According to the study, aversion therapy was commonly used on gay people in the military – not just soldiers, but also civilians referred by officers, chaplains and camp doctors. According to the study, “it is known that the military has a history of doing sex change operations— many sex changes were done in Military hospitals”. (This was corroborated by interviews conducted by Daily Maverick, as well as by participants in the aVersion Project study.) The study raises the question of how consensual the surgeries were. Disturbingly, the answer is not always clear.

Despite the human rights abuses perpetrated against gays and transsexuals, there was a paradoxical subculture within the military where alternative gender identities also found a home, the study reports. “There was a guy in our unit who was a transsexual. He was one of the most popular guys,” one participant related. “He was very popular because he was a total non-conformist. He managed to keep quiet about his transsexualism.”

The trans subculture kept going well into the 1980s under the Apartheid government’s noses. JW, who transitioned in 1985, told Daily Maverick about a secret club called the Phoenix Society. Members communicated through veiled messages in a magazine and contact details for the headquarters were published in the Dear Abby section of the country’s soft-porn rag, Scope.

“It was primarily one of the secret societies where the members were not free to communicate with each other unless by mutual agreement. The normal way of communicating with members was by writing stories for the Society Magazine called Fanfare,” says JW. “The members were usually ultra-closeted in those days. Through being Membership Secretary of the Phoenix Society for a few years, I realised that there were people the same as me all over the world. However, I soon realised that most of them were quite content to just get dressed up for a while and leave it at that. I used the Fanfare to record a series of articles as I grew to know more about myself.”

Some of these underground encounters – living as one gender by day and another by night – did have their lighter moments. “I really only discovered the freedom it gave me when a friend, a transvestite from Durban, came down to spend a weekend with me,” says JW. “I took her to have her hair done and we went out for supper and a show. At around about five o’clock she was starting to panic and I asked what the matter was. She replied, ‘I’ve got to go home to shave!’ Sue was one of those chaps who had to shave twice a day.”

In the eighties, says JW, surgery could be done at Groote Schuur, but the doctor in charge of approvals functioned as a “doorkeeper”, and men could not get approval unless they turned up “in fishnets and with knitting”.

Women wishing to transition, on the other hand, had no term to describe them at all – “because women could dress as they pleased.” So any gender dysphoria tended to be dismissed.

“In those days, even in the Phoenix Society, if you went as far as to have a sex change, there was a feeling that it was because there was maybe something wrong with you and you couldn’t put up with the pressure,” says JW, who is now 80.

JW transitioned in 1985. “As I came to terms with myself, my firm took one look at me and they said, ‘You aren’t going to do that here.’ I had been working there for 22 years. I lost my company car. I had had a pension, and I lost about 60% of what was coming to me. I got about three months of compassionate leave and a small payout. I lost my marriage. The divorce was very bitter. I lost everything.”

In spite of that, what was the transition like?

“What is my name?” asks JW. (JW’s name means ‘happiness’.) “That is what it was like.”

Present

So what has changed? There have been numerous positive developments in South Africa in the intention to provide gender equality, but trans people still struggle on the ground.

According to Deyi, the greatest struggles occur on a practical level, ranging from education to banking to law enforcement – mostly due to bureaucracy and lags in updating documentation.

A huge challenge lies within the SAPS, says Deyi. For trans women who opt for sex work because they struggle to find other employment, arrest is a very real threat – and the police are legally obliged to classify them according to the sex listed on their ID document.

“Being put into male cells is extremely dangerous if you are feminine expressing,” says Deyi. “And if you are incarcerated, how do you access hormones? The body masculinises. Depression and suicidal tendencies follow. You can’t have someone who is female identifying with people who are male identifying. The machismo that is enacted on those bodies is extremely dangerous. We have spoken to the department of correctional services and the SAPS are now obliged to ask who the person is more comfortable being searched by, but the police cannot move away from the identity document.”

Some police stations in Khayelitsha have gender neutral cells following the O’Regan commission, says Deyi. “Is this being adhered to on a consistent basis? These are the issues that we deal with.”

Women’s shelters are also a challenge for trans women. “Sometimes trans women who have been in abusive situations are turned away because the other women in the shelter are uncomfortable,” says Deyi.

The law enforcement challenge also applies during roadblocks, says Deyi. Transgender persons are advised to carry affadavits stating that they are transgender so as to avoid suspicion when coming into contact with authorities. However, constantly being ‘outed’ can be traumatising.

“Identity documents have a very visibilising effect,” says Deyi. “As cisgender persons we carry them as an afterthought. We never really think how it affects our recognition as citizens. Home affairs does not have a mechanism in place; it does not allow you to change your name and your gender at the same time. So you have a situation where your name reflects your gender but your gender descriptor is wrong. You then face suspicion, for instance in banks. They are not being malicious; it is a Fica requirement. We have had people investigated for fraud because of this inconsistency. We have tried to get home affairs to understand this real world application.

“Also, when you change your ID number, there is a period where your old number is inactive, but your new number has not yet become active, so in effect, for a period, you are stateless. You can get lost in the system. How do people register you or find you? Your bank accounts can get frozen, you can’t access funds – and this process at home affairs can take anything up to seven years, where you are deprived of the means to be an active economic agent.”

Eleanor (22), from Malawi has not yet been able to “attempt changing my gender marker or name in my ID”.

“Often when I have to present my current ID it leads to uncomfortable situations where I have to give someone at a bank, Vodacom store, etc. my life story just to finish up a simple transaction. These people seem to feel entitled to ask personal questions about my genitals, my love life and so on, long after establishing that my ID does indeed belong to me. As someone with social anxiety, these situations can cause me to have anxiety attacks. Not fun.”

Further challenges include education policy, where gendered school uniforms, regulations and gendered sport participation remain a challenge. Children have been known to phone their parents and ask to be taken home to use the toilet because they did not want to use their gender-assigned toilet at school or feared bullying. In some situations, gay or trans teachers have been sympathetic to students, but been afraid to stand up for them for fear of being viewed as “too friendly” or being discriminated against themselves.

There are also inadequate transitioning policies in workspaces, says Deyi – sometimes boiling down to ignorance and sometimes outright discrimination. “One person called us and said he had applied for a job as a female, took leave, now he had done his top surgery,” she relates. “He came back to work, and his superior called him in and said: ‘You have to reapply for the job because you are messing up our BEE stats; we hired you as a female’.”

Similarly, paternity and maternity leave policies do not yet cater adequately for gay or trans persons.

Medical access also remains a significant challenge. Firstly, because South Africa has the most progressive laws in Africa, trans people from neighbouring countries often come to South Africa for surgery, but then are unable to access hormones in their own countries. However, hormone access is not always that easy here either.

“I’ve struggled immensely at times to get my medication,” says Eleanor. “As someone without medical aid or a stable income I get my treatment at government hospitals. I’ve gone months without medication because of so-called shortages (though a few hours of complaining often causes medication to appear out of nowhere). And even when I do get my meds hospital staff are reluctant to give me the indicated dosage on my script as the dosages 10 times higher than what would be given to a menopausal cis woman, which is what MTF HRT drugs are mainly used for.”

There has, however, been progress. “There have been a few major positive developments for trans folk here in South Africa, from the Constitution to government healthcare,” says Eleanor. “But very recently we’ve begun to develop a community and the reactions I’ve seen from other trans folks as a founding member of CtrlAltGender (a trans support group) and an administrator on the Facebook group ‘Trans* Women South Africa’ is that of immense relief, belonging and pride at finally meeting other folks in the same boat. I’ve met trans people in their 40s, 50s, 60s who have never met another trans person and didn’t have the first idea how to get medical help, which companies are trans friendly or even just have a friend they can confide in.”

Social acceptance is much easier to find than in the days of the secret Phoenix Society – even for people like Eleanor, whose families did not accept their gender identity. “The amount of support that I’ve received from my friends (both cis and trans) after I dropped out of university and my parents’ pocket has been amazing. I have friends who have given me shelter when I faced living on the street, they have provided for me when my pockets were empty, kept me safe when depression got the best of me and loved me through thick and thin,” says Eleanor.

According to Deyi, gender fluidity and traditional values are not necessarily incompatible either. For some trans men with accepting families, a symbolic circumcision becomes an affirmation of their newfound manhood – even if they have not had bottom surgery. “For persons with female bodies who want to transition, circumcision can be a confirmation of their manhood. There are trans men who have gone through initiation but have not had bottom surgery,” she says. “I am not sure exactly how that works, but the cut is symbolic. They are initiated in a symbolic way. It confirms and affirms the person’s gender.”

Healthcare is also improving, although the system is overloaded. Waiting lists – particularly at government hospitals – are extremely long and, as with every branch of medicine, there are just too many patients per doctor. However, the bright spot is the standard of medical expertise. “Government health care in South Africa for trans folk is phenomenal from my experience,” says Eleanor. “Although our government hospitals leave lots to be desired, the availability in Gauteng and Cape Town of free access to psychological, psychiatric, endocrinology and voice therapy, as well as to surgery is fantastic. The standards of care and experience have been great.”

Lastly, the tireless work of groups like GenderDynamix to increase awareness and drive the necessary updates to legislation is paving the way for further progress.

Future

A key challenge is to reduce stigma against gender dysphoria, says Deyi. “Doctors say they don’t want to operate on a healthy body, but this condition is there in the medical books,” she says.

Furthermore, she adds, in many cultures multiplicity in gender identities is only pathologised once a child (or adult) is taken to a clinic and diagnosed. Until then, the person is allowed to express their gender however they wish, which often reduces the desire for surgery. “Rural families tend to be a lot more accepting of their kids who are gender variant than urban families,” she says. “Particularly in rural KZN, people have been living as their preferred gender forever, and now they are seeking hormones. And we say, ‘But you have been living like this’ and they say, ‘Yes, I just want to feminise or masculinise a bit’.

“A lot of times people who have been accepted do not want to transition hormonally because they want their families to be able to identify their bodies if they pass away, and they want their ancestors to be able to recognise them in the afterlife. In a lot of intersex cases in traditional settings, because people have home births, it is viewed as something natural. The child is raised very gender neutrally until someone comes and says there is something wrong with them.”

Deyi points out that children who are allowed to develop their gender identity without pressure are typically less likely to seek surgical transitions. In Sweden, she points out, adolescents who are allowed to use hormone blockers (which delay puberty but allow the body to grow normally) are relieved of the anxiety of sexual development and are spared the gross revulsion towards their bodies that tends to be associated with severe gender dysphoria. Statistically, these adolescents are less likely to opt for surgical transition and less likely to develop severe gender dysphoria. But the ethics of allowing children to choose whether they want this medication is a legal minefield.

These examples illustrate, however, that allowing children to grow unpressurised is hugely beneficial.

“I welcome the stage which to a large extent we are at now where people can – I believe the modern word is gender fluid, where you can be far more gender fluid and yet explore other sides of your personality,” says J.

Greater awareness will also help, both in the medical field and outside of it. “This is where we’re talking about needing a body of medical people who are trans friendly, in the broad sense of the word, who can advise, treat and in some cases prescribe,” says J. “We need a pool of information which includes doctors and psychologists, and we need to tell people that this pool is available. That is really what I think we should be focusing on in order to help.”

“Sadly most LGBTQIA+ communities and projects are by and for cis gay white men, which definitely needs to change,” says Eleanor. “Polysexual, asexual, trans, gender non-conforming, intersex and polyamorous people need to share in the limelight. We need to adopt intersectionality, the idea that all oppression is connected.” DM

Photo by Sodanie Chea.