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CHANGING GENDER: Things that matter!

Many of my transgender patients want to go through the process of having their names and gender markers changed on their IDs. I provide them with the letter they need, but the process involves much more than that.  I asked one of my patients, Max, to share his journey with you, which he very kindly and eloquently did!  I hope you find this helpful.

Dr Elna Rudolph
Clinical Head of My Sexual Health

 

Max’s Story: My 2 year application process

Last week I confirmed that my new ID book is in the final stages of processing; my name has been updated, and the gender marker change is receiving final approval. If all goes well, I should be able to collect it in 10 working days. Given that this can be quite a challenge and has taken me over 2 years, I am feeling particularly grateful that my experience has gone smoothly. In fact, when that little green book is in my hands, I plan to post feedback to the Department of Home Affairs through as many mediums as possible, commending them on this instance of service delivery. Sometimes they do get it right and it impacts lives! I hope that soon it can become the standard experience for all.

In the months since I applied in June 2014, I have received many requests for information regarding the process of updating one’s ID book. So I thought it would be helpful to write a post detailing all that I know. I will fight this fight until I help others to complete their process.

Changing gender

In terms of section 27(A) read with the provisions of the Alteration of Sex Description and Sex Status Act (No. 49 of 2003).

Applications can be made by:

Persons who have undergone a sex change operation or medical treatment resulting in their gender reassignment.  In such cases two medical reports are required:

  1. one by the medical practitioner who applied the procedure or medical treatment or by a medical practitioner who has experience in such procedures or treatments, and
  2. a report by a second medical practitioner who has independently examined the application to established his/her gender.

Your Rights As A Transgender South African

Our constitution is actually very progressive, particularly around the rights of transgender individuals. In 2003 the law was changed to allow transgender individuals to change their name and gender WITHOUT having any kind of surgery. In Section 1 of Act 49, it states:

“Any person whose sexual characteristics have been altered by surgical or medical treatment resulting in gender reassignment may apply to the Director General of the National Department of Home Affairs …”

The key term to take note of here is “gender reassignment” which is defined in the legislation as:

“… gender reassignment means a process which is undertaken for the purpose of reassigning a person’s sex by changing physiological or other sexual characteristics, and includes any part of such a process …”

This statement is really very helpful because it means that 1.) gender reassignment is recognised as a process that happens over time, 2.) is not limited to alterations made to genitals, and 3.) that there is no specific juncture within such a personal and individually varied process that must be reached before a person “qualifies” to change their ID book. This is truly revolutionary and very empowering; in a country where a vast majority do not have the resources to consider surgical options, being able to align their ID documents is a vital step towards their true expression being recognised.

** It is important to note that gender reassignment, as it is currently defined, is still dependent on some form of medical intervention. “Sexual characteristics” refers to either primary (genitals) or secondary (hormone-related identifiers) characteristics and are required to reflect, to some degree, one’s identified gender expression.

In Short: you must have undergone surgery and/or be on HRT (Hormone Replacement Therapy or rather Gender Affirming Hormone Treatment as we prefer to call it) such that primary and/or secondary sexual characteristics align or are aligning with your identified gender in order to amend the gender marker in your ID book.

Where Is Gender Marked In A South African ID Book?

Gender is indicated within your unique ID number. The first six digits reflect your date of birth. The next four digits are where gender is indicated. A value less than 5000 correlates to female, while greater than 5000 correlates to male.

990101[XXXX]1111

When you apply to have your gender amended, you will receive a new ID number. The four digit gender marker should then correctly reflect your identified gender.

What Do You Need To Apply?

  • Form BI 526 (application for an amendment)
  • On this form you indicate which of the particulars are erroneous (in this case, gender) and you are applying to have amended.
  • Form BI 9 (application for identity book/card)
  • Form BI 24 (notice of birth)
  • This form must be filled in twice
  • The first form is filled in with your assigned gender
  • The second form is filled in with your identified gender
  • VERY IMPORTANT: on the first letter (assigned gender) write “OLD” in big, bold letters on the top of the form. On the second letter (identified gender) write “NEW” in big, bold letters on top of the form.
  • In Summary: both forms are filled in with identical information EXCEPT your gender, with your old information on the form you have indicated as “OLD”, and the information which your ID book should be amended to on the form you have indicated as “NEW”.
  • 2 letters from medical professionals who have assisted with gender reassignment (or affirmation, as we like to call it):
  • Both letters need to state that gender reassignment has taken place. Please refer to the next section for more details and samples.
  • The first letter should be supplied by your main doctor, typically your surgeon or doctor prescribing your hormones .
  • The second letter simply needs to confirm the first letter, and can be supplied by a psychologist, GP, or other medical professional assisting you.
  • A copy of your birth certificate
  • Your existing ID book and a copy thereof
  • Full-colour photos for ID (at least 2)
  • R 210 [R 70 – gender amendment; R 140 – reissue of ID book]
  • I paid less than this, but the fees are subject to change. Better to be prepared and take a little extra.

When I applied for my change I did not need the copy of my birth certificate, but I also had to get slightly different forms. Sometimes the DHA will not be as organised as we might like, so I recommend taking as much with you as possible, and be prepared to adapt.

Supporting Letters

As stipulated above 2 letters are required to support your application to change the gender in your ID book. Once again Gender Dynamix has been most helpful and supplied me with an overview – which you can send to your doctors – of exactly what the letters should say.

Through helping individuals in the country with this process GDX has found that the implementation of Act 49 is not always carried out correctly. Unfortunately, clerks often do not pass on applications to the relevant legal department and instead make judgements according to their own opinions. GDX has found that letters that are phrased briefly and to the point are fast-tracked. It is not required to provide details regarding the individual’s process. So long as your medical professionals state that gender reassignment has taken place, then the requirements have been met. The overview also states that GDX has ensured that such brevity is completely legal, which may come up as a concern for your doctors.

How Long Does It Take?

This is one aspect where the law and the implementation of the law do not line up. Due to the safety concerns for someone whose presentation and legal identifications may not match, the importance for efficient turn-over times on re-issuing ID books has been recongised. Ideally it should take no longer than 8 weeks to receive your new ID book. But at DHA you will be informed that the waiting period is 6 – 8 months. We can only hope that this will improve as processes are streamlined. Even though mine took 2 years with a fight.

Final Notes From Me

I submitted my application through the Department of Home Affairs Krugerdorp in Gauteng. I recommend them because my overall experience was very positive. I was incredibly nervous and prepared at any moment to have to deal with discriminatory behaviour, but everyone that I asked regarding forms and procedures was very helpful, polite and able to provide the answers I needed. The individual that processed my application was particularly wonderful. Due to the fact that amending your gender entails a long waiting period, I wanted to change my name at the same time. I was told that every amendment needed to be done separately, but when I appealed to the lady processing my documents, she allowed me to submit both changes at once.

My advice: be over-prepared.

We all know that at any DHA everyone is impatient. So the faster you can be processed, the happier everyone will be, including the person processing your application. Be polite, and if you need to argue, logic and flattery (in my experience) are the way to go. If you want to change your name and gender at once, for example, I suggest pointing out that doing both in one saves them time, effort and paperwork.

** make sure that when you pay for the services that the cashier notes that you are paying for multiple amendments. My application was briefly delayed when I had to return to the DHA to pay for the name change, which the cashier had not noted the first time round.

Be aware of the reality. It is quite possible that you will encounter difficulties, whether discriminatory or administrative. Try not to part with original documents and provide copies instead. Keep your copies of the application forms, and take note of the reference numbers on them. Breathe deeply, know that it is your right to have an ID book that reflects your identity correctly, and there are organisations to help you if you do have issues.

Finally, if you can, have someone to support you and go with you to DHA. My partner came with me, and was a very steadying presence during the process. Especially if you are nervous, having a significant other, family member or friend with you can be very reassuring.

Track The Progress

I highly recommend calling the DHA Hotline at 080 060 1190 on a regular basis (every 2 weeks) to checkup on the status of your application. Make sure to ask for a reference number after each call. Don’t panic if for several months the status is some variation of “being processed”. GDX does offer to assist with tracking applications. If you email them your details, the date that you applied and the reference numbers of calls you have made, they will follow up with the DHA. I did not need to call in the backup, but if you do experience any problems I recommend contacting them.

There is also a mobile app you can download that queries the DHA database. It was very exciting to see the status go from Step 1 of 4 to Step 2 of 4, but beyond that it has been too vague to be helpful. Phoning in was far more satisfactory.

So there you go. I hope this proves helpful and worth the read to anyone seeking to amend their ID book. I’m sure the process will change in time.

As hard as it is to be patient and wait just remember it will be worth it at the end.

I’m a email away: maxtjacobs@gmail.com

A phone call away: 0814905451

Facebook: Things That Matter Trans Support

 

Find more information on transgender sexual health here, or read our blog articles relating to all transgender matters.

Max is a patient of Dr Elna Rudolph. For enquiries, please contact My Sexual Health.

Dr Elna Rudolph
Dr Elna Rudolph – Medical Doctor, Sexologist and Clinical Head of My Sexual Health.
086 7272950
www.DrElnaRudolph.co.za
www.mysexualhealth.co.za
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Sex Q & A with Dr. Elna Rudolph

Sex Q & A with Dr. Elna Rudolph

Dr. Elna Rudolph answers a few questions about sex.

My partner wants to try anal sex more often, but I don’t enjoy it. I’m worried that if I don’t do it, he will feel unfulfilled…

There are certain no-no’s when it comes to sex in relationships and they are different for each couple. The one might never want to have sex unless she first had a shower, the other will never allow oral sex, and another will not do it with the lights on. These taboos should be respected by the partner, but it does not mean that they cannot shift when the reasons behind them are explored and some basic information with specific suggestions are given in the form of sex education or formal therapy.

When it comes to anal sex being one of the taboos, there are usually two reasons: Firstly some people have religious or moral issues with it. These can be quite difficult to shift and should sometimes just be respected. The other reason is that it is just too uncomfortable and therefore really not enjoyable. Guys expect that they will be able to just penetrate their partners as easily as it looks in porn. The reality is that most people have to go through a process to get used to being stimulated first around and then in the anus. Start with some light touch and rubbing and then move to inserting a well lubricated little finger and then progressively go larger from there. If you are really committed to it, you could also practice by yourself to get used to what it takes for the anal sphincter to relax. Like any muscle, it has the ability, but it takes time. If you perceive the attempt at penetration to be threatening and you anticipate the pain, the muscle will just go into spasm and make it more difficult and unpleasant.

How many times a week is it normal to masturbate? I’m in a long-term relationship and masturbate at least once a week, but my partner says he never does.

It depends on many things. If there is so-called “desire discrepancy” in a couple (which is the case in most relationships!) the partner with the higher desire is left frustrated if he or she does not masturbate. Masturbating is also a form of self-loving and soothing. You might get something completely different from masturbating than what you get from sex and therefore remain to have a need for it although you are in a very sexually fulfilling relationship. More than five times a week probably becomes excessive (according to international definitions anyway). It is also normal to never masturbate if you are in steady relationship. Whatever works for you.

I found a stash of lesbian porn on my husband’s computer and watched a video out of curiosity. It really got me off. What does this mean? Am I a closet lesbian?

Not necessarily. Up to 80% of women get turned on by some girl-on-girl action! You are a lesbian (if we have to use such a rigid term) if you would like to build a life with another woman. If lesbian porn excites you, you have just expanded your repertoire of excitement and fantasy.

I sometimes feel like my husband and I are more in the best friend zone than sexually connected. What can I do to get the spark back?

Make sure that you create special experiences when it comes to sex. The longer the relationship, the more difficult it is to create more and more exciting sexual experiences and then you get stuck in a rut.

It is however possible to create a special experience in a different way each time. Take time to make love through sensual massages and external stimulation, do the romantic candle lights and special music thing, make regular dates for love making, increase the oxytocin (bonding hormone) between you by looking each other in the eye, hugging and cuddling – all things to make a concerted effort to say: this is a special relationship with an intimate bond, not merely a friendship.

The more you are like friends, the more difficult these things are, but get started sooner rather than later!

How do I get my partner to go down on me more often?

Ask for it! Make sure you have the hair and hygiene under control and buy some special lubes that taste nice to encourage him. Returning the favor also goes a long way in encouraging him! (His favour might not be oral sex, it might be something else he loves that you are not doing frequently – find out what that is).

My guy doesn’t know how to make me climax – while he’s well-endowed, he’s not an expert at making it work. How do I nudge him in the right direction?

Firstly, you have to be honest about the fact that you are not getting there. Make it about you, not him. Tell him that there is only a specific way that works for you to come and you want to show him how to help you to get there. Show him how you do it and let him get involved in taking over more and more of the stimulation each time.

If he is offended by this and does not want to cooperate, think twice about sorting out a budget or raising kids with him!

How do I tell if he has an STI?

Sometimes you see a discharge, sore, blister, bump or wart in your genital area. It might have a bad smell or burn when you urinate. The reality is that most of the times you won’t even know about it. You will have to get tested.

I’ve just woken up from a night of tantric sex, but I’ve broken out in a nasty rash – I think it might be from the latex condoms we used. Are there any others we could try?

You could get latex-free condoms, but they are very difficult to find. Order them off the internet. It can also be due to oils you used for massaging.

I’m really in love with my partner but I struggle to get turned on by him. What should I do?

Check your hormone levels. Getting turned on is heavily dependent on testosterone. If you are taking an oral contraceptive, it breaks down and block your testosterone and therefore it is difficult to become sexually aroused. Some women just don’t produce enough testosterone. It can be supplemented through the skin, though. Never ever through injections!

My partner is amazing in bed, but he enjoys taking drugs before sex. I sometimes do it with him, but it bothers me that he wants to be high when we’re having sex. How do I tell him?

Be honest about it. tell him that you value the relationship and that you would like to have real intimacy with him and not just a fun, exhilarating experience. Ask him to do it your way every second time.

My partner is always super aroused when we’re in public, and not so much in private. While the thrill of getting caught is sexy, I’m over the riskiness. How do I get him to be as aroused when we’re at home?

It has to do with his sexual arousal template that was probably formed in his brain before the age of nine! He will have to learn that he has a very rigid arousal template and that it can actually be adapted and expanded. He also has to learn that sex is sometimes not that exciting, sometimes it is more special and for the purpose of bonding than for the purpose of that ultimate high. Guys with a rigid arousal template often have problems with real intimacy and if the problem is really severe, it should be addressed in therapy.

I’m very attracted to my partner, but during sex, I get uncomfortable and clamp up. How do I get over this?

That sounds like it could be vaginismus. We are a team of professionals that specialise in helping women deal with this problem. I wish there was a one-liner answer to that one, but unfortunately there isn’t. It’s usually caused by a combination of medical conditions, childhood trauma, religious upbringing with excessive guilt, poor sex education, psychological as well as relationship issues. These all need to be addressed for you to stop clamping up with the man you love.

Help! His penis is too big!

You can use muscle relaxants, better lube, vaginal dilators and even physiotherapy to get over this hurdle! There is also a device from Pure Romance, called Super Stretch Lips, that you can put over his penis to keep a part of it outside of the vagina during intercourse, but it is usually the girth that is the problem. Make sure you have pleeently of foreplay in order for your body to get ready for penetration.

Help! His penis is too small!

Make sure you get satisfied before penetration happens. You can also do kegel exercises and even see a physiotherapist that specialises in the area to help you strengthen your muscles in order to “feel” him better. A device like a We-Vibe also helps to improve the sensation during penetration if you need more than what he ‘has to offer’.

My boyfriend asked me to stick a finger in his bum while we were having sex. At first, I wasn’t keen, but eventually I agreed, and he said he had the most intense orgasm ever. Now he wants to do it all the time. Does this mean he’s gay?

No, not at all! It just means that he has discovered his p-spot. The nerve that supplies sensation this area is the same as the one that supplies your clitoris, so you do the math.

My new boyfriend has marathon-runner stamina in the bedroom. Sex goes on forever. I actually start getting bored and sometimes even chafed. How can I make him come faster?

Ask him to! If he can’t, he has what is called delayed ejaculation. Although it is a difficult condition to treat in sex therapy or sexual medicine, it can be done. Firstly, check if he is not on anti-depressant drugs that may be causing the problem. That can easily be changed to a different type, if it is the case. You can also tell him that you will help him come in another way or he can get himself there (which is usually much quicker) but you are only up for ten minutes of penetration in any one round (the vagina struggles to stay lubricated for longer than that in most women).

I want to do a striptease for my guy but I’m really uncoordinated and I’m worried it’s going to be more comedy than sexy. What’s the best costume to wear that’s easy and sexy to remove?

Probably a man’s shirt, tie and a top hat. Make sure you have the sexy stockings with dispensers and heals that you can still move in to complete the outfit (or at least that is what I’m told by the Carmen Electra Strip Tease DVD that was given by a friend! Not exactly the content covered in a Master’s Degree in Sexual Health!).

I don’t feel pain during sex, but afterwards, I bleed for two to three days, as if I’m having a period. What’s up?

You probably have an infection. See a gynae or doctor who knows something about this as soon as possible! Worst case scenario – it might be a cancer, so don’t wait!

I had my period twice last month. Google says it may be due to stress and my diet. But now I’m feeling some pain below my stomach. What could it be?

Ovarian cysts can cause abnormal bleeding and lower abdominal pain. You need to see a gynae or at least get a pelvic ultrasound done.

What can I do to reduce wetness before and during intercourse?

It may sound a bit strange, but you can just be practical about it and keep a towel handy to remove some of the excess moisture. We also compound a special cream to be applied into the vagina prior to sex to reduce the lubrication. Just also check for an infection. Sometimes the wetness is not lubrication but actually from an infection. Another option is to go onto a low dose estrogen contraceptive. That often causes vaginal dryness which could help in your case.

How do I tighten and strengthen my vaginal muscles?

You can get lots of information about Kegel Exercises on the internet – with different variations and programmes. Many women find it difficult to isolate these muscles and end up squeezing everything but their vaginal muscles. There are physiotherapists who specialise in this area. They will teach you how to do it through biofeedback.

My husband is 63; I’m 31, but he wants sex every day – sometimes twice a day! I can’t keep up. What should I do?

It can be that he just has a very healthy appetite but it can also be that he has a discomfort in his pelvic area that is released through intercourse, something called persistent genital arousal disorder, or it might be that he has an addiction. With professional help, it can be established which one of the three it is. The point however, is that his high desire cannot be your responsibility. You can have sex as many times as you are willing and able to, but the rest of the time, he will have to sort it out himself.

It can also be a hormonal imbalance which can be addressed medically, so get help if you are taking strain.

I lost my brother six months ago, but am still feeling the loss so I have bouts of depression that kill my sex drive to the point where I don’t even want to be touched or kissed, and its taking strain on my marriage. I can’t take anything hormone based as I have a factor 5 laiden disorder. Is there anything I can do or try to help me out my slump?

One the one hand you just have to be patient with yourself and give yourself time to get over this extremely traumatic life experience. It takes time and it is normal to lose your libido when you have depression.

On the other hand, make sure you get professional help. See a psychologist and take an anti-depressant that does not take your libido away. Something that works very well, but only if you are not anxious, is a drug called bupropion. It can actually boost your libido even if you don’t have depression.

My cramps before and during my period are awful! Is there anything I can do to ease them?

You can go onto the pill or have the Mirena inserted. Natural medicine like Premular or Femiscript also helps. Many women find benefit from using Evening Primrose Oil.

My IUD cut my guy during sex. Is something wrong?

Yes, definitely! It is falling out and probably not effective as a contraceptive anymore! Have it removed and replaced immediately. Sometimes when the strings are cut too short, they sting the partner, but if he got a cut, it was from the actual device itself and it should be removed.

My partner and I are both virgins. How can we make our first time really special?

By taking it really slow. Make sure you have covered base one, two and three before you try to have sex. Also make sure he can insert two fingers into your vagina without hurting you. Don’t expect to have orgasms, just enjoy the uncharted waters of really being one for the first time. You can add more movement and stimulation as time goes on.

My friends say they love having their nipples played with. Mine aren’t sensitive so I don’t really enjoy it. Is there something wrong with me?

No, you probably have other areas that get you going, focus on those and make sure you partner knows about them. If they are not very sensitive, normal kissing and sucking might not feel like much to you. Try a bit more pressure that goes towards pain (but not painful) – that could be very intense and pleasurable for women with nipples that are not very sensitive. Vibration also makes a difference.

What does an orgasm feel like?

It is different for every women – some say it feels like sneezing and others like dying! You have to find out for yourself. One thing that all orgasms have in common is a climax (or a few of them) and then a fall. There is a definite point where you can feel that you are experiencing a release. If the release is gradual or the pleasurable sensation just kind of weans off, you did not have an orgasm. You will know if you did.

I keep getting yeast infections, but my guy won’t treat himself at the same time.

Yeast infections love the vaginal pH, they usually don’t survive on a guy’s penis. The fact that you are getting recurrent infections is not due to him not being treated, it is most likely due to you not being sufficiently treated, or it might not a yeast infection but bacterial vaginosis or even an STI. If it is an STI, he will need to be treated as well. Guys get candida only if they have very low immunity like with HIV or diabetes.

Getting rid of yeast infections often require repeated regular dosages of oral anti-fungal medication, restoring the balance of the pH in your vagina and removing triggers for yeast infections like bubble baths and food that is high in sugar.

We often see atypical yeast infections like candida glabrata. You should get a vaginal swab MCS and ask for specific culture and sensitivity for the candida.

 

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From one trans to another

Coming to terms with being Trans is incredibly difficult. So is telling people, if you choose to. You spend all this time obsessing about how they are going to take it, or worrying about others simply not understanding. You spend hours trying to think of different ways to explain the concepts of sex and gender in a way that everyone will comprehend, and at some points, you have to accept that there will be people who will never “get it”. You mull over how people will react if you change how you look, what you wear etc. You worry about whether or not people will invalidate you for wanting to look a certain way. You try so hard to “pass” because not passing means constant ridicule, and you spend so much time trying to figure out how to change your voice, how to change your face, just so you can feel more like yourself.

Even then, people will not always be kind. People are rarely kind about things they don’t understand. So sometimes, Trans people don’t ever come out. They stay hidden, because being hidden is easier than loosing everyone. It is easier than being labelled a freak. It is easier than being completely alone. As a trans person who went through these feelings, and still going through them, I want to tell other trans people that things really do get better. Whether you are out or not, being yourself is always the best idea. Yes, people are going to be shitty about it. That is almost guaranteed. You will get better at hearing transphobic comments. Some days they will bother you a lot, but you will find people who will help you through that. You’ll find out who your friends really are. I certainly did. I thought I was going to lose everyone I loved, but I didn’t. Yes, I lost some people, and you will too. But you don’t need people like them, people who can’t accept you for who you are. Being yourself is like breaking out of a cage; it’s going to be painful at first, and every once in a while you might lose your footing, but you are free. Nobody can take your freedom from you and it is so worth being free.

What I am trying to say is be yourself. There is no one else like you. Nobody can invalidate you. Nobody can take away from the content of your character. At the end of the day, you have to look at yourself in the mirror and feel content with what you see. That is what matters. The rest will fall into place. You are brave enough to be yourself; each and every one of you. You will not ever really be alone. You won’t lose everyone. You will grow a thicker skin than you ever thought you could, and one day you will feel so happy with yourself that hateful comments will simply make you laugh. It is hard to see it now, but it is possible and it will happen. YOU are human! You are not the names people call you. Your value is decided by YOU, and no one else. The most important thing in life is to be happy with yourself, and you will be. You will be fine.

– Anonymous –

All images courtesy of Google

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