Fortis Hospital in Shalimar Bagh in Delhi recently conducted gender reassignment surgeries on two 22-year olds with gender dysphoria.

The first patient, a 22-year-old transwoman who had faced humiliation and bullying almost her entire life, says she has finally thrown out the "masculine cage" that imprisoned her soul, after a gender reassignment surgery. The patient suffered from what doctors describe as "gender dysphoria", the condition of feeling one's emotional and psychological identity as male or female to be opposite to that of one's biological sex.

"I was a female trapped in a male's body. I was bullied in schools, humiliated in college and faced job rejections," she said. The woman hails from Lucknow and had enrolled in an engineering college. "One day some boys tried to sexually assault me, forcing me to drop out and crawl into isolation for one year," she said.

Both patients shared their life struggles at a press conference organised by the hospital on May 31 where they were operated for gender reassignment. The first patient who underwent surgery last October, is married now and working as an executive with a private airline. The second who recently walked the ramp at a popular fashion show, underwent the gender reassignment surgery in February this year.

Richie Gupta, director of department of plastic, cosmetic and reconstructive surgery at Fortis Hospital in Shalimar Bagh in Delhi, said in gender dysphoria cases a person's mind (gender) is at conflict with the physical body and sex as assigned at birth. "The condition has a definite neurologic, genetic and hormonal basis, as proven by scientific research. The first step is to make a firm diagnosis of gender dysphoria, and to rule out psychiatric conditions such as schizophrenia. This is done with the help of psychometric analysis and opinion of two different psychiatry teams.

"Once that is done, the they also have to undergo endocrinological evaluation and hormone therapy... They must undergo real life experiences living in desired sexual role, in these cases, as a female for a period of more than two years," he said. The hospital authorities said the facility follows the guidelines laid by World Professional Association for Transgender Health.

"In the two cases, after hormone therapy, surgeries were done (feminising genitoplasty), which involves removal of penis and reconstruction of new vagina, clitoris and labia. Breast augmentation is required in a few cases, in which sufficient breast enlargement does not occur even at eighteen months of hormone therapy, or where the transwoman specifically demands the procedure," Gupta told reporters.

Optional procedures which facilitate them in the desired sexual role in the society include, voice-change surgery, hair transplants, rhinoplasty, liposuction and facial feminisation surgery, which consists of forehead and jaw shaping surgeries, he said. Gupta said a transman or transwoman can live normal sexual life but "cannot biologically produce children". "However, their sperms (in case of male-to-female) or eggs (in case of female-to-male) can be preserved, and they can go for test-tube baby or become parents through surrogacy later," he said.