Transgender women can conceive babies with womb transplant

Dr Irengbam Mohendra Singh *

Americans who stick to the guns and god do most things that are ungodly. They may perhaps, be excused because a passage in the Bible says: "But God chose the foolish things of the world to shame the wise" (Corinthians 1). In postmodern philosophy, there are reasons for ending false supremacy of big gods over small gods. What can Hindu god Ishwar offer that Meitei god Atiya Sidaba can't?

And between godliness and naturalness breaks the news this week that 78 year old American professional golfer Jack Nicklaus is playing golf again. His severe low back pain from childhood, had no more pain since he had stem cells taken from his abdomen, were inserted into his low back, last year in Munich, at a mere cost of $50. That's anti-god. God made humans erect despite their weak low back without any bony support in front. It was alright when human predecessors were walking on four legs like horses.

Anti-god male pregnancy first made headlines in the US in 2017 when a transgender man in Oregon, gave birth to a healthy boy. Transgender women are now hopeful of becoming pregnant though they have been born biological males. Science has ruthlessly been working to change all the hard works of gods.

I on my part, having run out of things to write because of my limited knowledge, have been homing in on new scientific discoveries and then surfing the internet to digest and communicate knowledge in nit little packages for the youth in Manipur. There's some chauvinistic glee to be had from this, but the inconvenient truth is my intelligence has become simply another digital commodity, open-source intelligence.

Transgender is a term used to describe people whose gender identity differs from the sex they were assigned at birth. Gender identity is a personal sense of being a man or a woman (a boy or a girl). The boy in all appearance i.e anatomically is a boy, but he may feel that he is a girl. A girl likewise may do so. They may describe themselves as transgender, transsexual or non-binary.

Transgender identity is different from sexual orientation that describes a person's (male or female) enduring physical, romantic or emotional attraction to another person of the opposite sex or the same sex or for both, e.g straight, gay, lesbian, or bisexual, while gender identity is the opposite internal feeling of a man or woman outside of what he or she is. The British Army emphasises tolerance and emotional support for transgender people, while in USA, President Donald Trump has said he will bar transgender people from serving "in any capacity" in the US armed forces.

Most transgender people prefer to bring their bodies into alignment with their gender identity. This is called "transition". In the transition process many transgender people are prescribed hormones by specialist doctors to change their bodies, either to male or female appearance, before they undergo sex change surgeries.

For female to male transformation, treatment with male hormones such as testosterone can help development of secondary sex characteristics of a man. It broadens her shoulders, gives hair on the face to shave and other male characteristic patterns of hair growth, masculine patterns of fat and muscle distribution that is more congruent with her gender identity.

It takes about 2 years. This can be followed by a variety of surgical procedures, such as surgical ablation of breasts and removal of uterus (womb) and ovaries. A realistic looking male genitalia can be reconstructed with re-enervation to have sexual feelings. Sexual intercourse is possible with penile implants.

Dr Richard Paul, President of the American Society of Reproductive Medicine, announced in November 2017 that transgender woman can have donated womb transplanted and can attempt to begin pregnancy as early as "tomorrow". He stressed that there was no anatomical reason why a womb could not be successfully implanted into a transsexual. "I don't see any obvious problem that would preclude it. While men and women have a different shaped pelvis, there would nevertheless room for an implanted womb. However, the pelvis shape would mean transsexual women could only give birth via caesarean section", he added.

Expertise in womb transplantation is being developed at increasing number of specialist centres worldwide. In Sweden, since 2014, at least five babies have been born to women who had received wombs in a series of operations. Other womb transplant procedures exist in Europe, and in the UK doctors have been given their own programmes to be funded by charity.

Womb transplant is complicated partly because the organ is located near a number of major blood vessels. Recipients have to undergo long term immunosuppressive treatment to prevent the organ being rejected.

Predictably, there are always some antagonists. I thought it's only Meiteis who are always pulling others down to their level. Some British experts have warned that initiating a pregnancy in a transsexual woman is unethical. And, if womb transplantation for natural women becomes freely available on the NHS (free) in the UK, hospitals may have to offer it to transsexual women because of equal rights laws.

Professor Julian Savulescu, a bioethical specialist at Oxford University, has this thing to say: "Uterine transplantation represents a real risk to the foetus, and future child. We ought to avoid exposing foetuses and future children to unnecessary significant risks. Public resources should not be used to fund the procedure for transsexual women". He makes this statement despite the fact that in the UK, about 7,000 women a year are born without a womb, and as if they are also born without the primal human desire to have offspring.

Transgender transition isn't a simple medical procedure. It is complicated and involves several stages: (1) social transition; (2) legal transition; and (3) medical transition, though they can be completed independently of each other.

The decision to medical transition is taken very seriously as it impacts upon one's entire life. It's stressful but it can bring immense relief to a transgender person, who can then live without fear, termed as dysphoria (an intense feeling of sadness, low mood and uncertainty – the opposite of euphoria).

In the "Social Transition", the person tries to exist in a society that finds him/her repulsive. The transition can be incredibly difficult and can expose the person to harassment and prejudice. Before the medical transition one may be necessary to live in society full time as you wish, under a requirement known as 'living in the gender role that is congruent with gender identity'. It is also called 'real life experience'.

In the "Legal transition", one has to formally change his/her legal documents, and records of identity, such as a deed poll or statutory declaration, as well as a doctor's note saying the person transitioning and intending transition to be permanent. An exception is your birth certificate, which requires what is known as a 'Gender Recognition Certificate'.

Non-binary individuals (also called 'gender queer', ie those with a gender identity that does not fit the male or female 'binary') may not have the legal option of an appropriate transgender title such as Mx (short for Mixter) – undetermined gender, or Misc (for miscellaneous), although this is increasingly changing.

The "Medical transition" relates to transforming an individual's body officially, through hormone therapy and/or surgery, as well as many other procedures, such as permanent hair removal from the body. This can be done privately or via NHS in the UK, but certain procedures are rarely covered by the NHS, such as facial feminisation surgeries or facial hair removal.

Hormone treatment is followed by surgical procedures. While many go through the medical treatment, some will not go through the whole gamut of long-drawn surgical procedures. Some will opt for some. There is the matter of price tag that will cost one an arm or a leg. In changing anatomical sex from male to female, testicles are removed (castration). The skin of the penis is peeled off and inverted, as a flap preserving blood and nerve supply, to form a sensitive vagina (vaginoplasty).

A small clitoris fully supplied with nerve endings can be formed from part of the glans ( the head) of the penis. If the patient has been circumcised (foreskin removed), or the surgeon wants more skin to construct labia minora, the scrotal tissue from which the pubic hair follicles are removed, can be incorporated within the vagina. Other scrotal tissue forms the labia majora.

In extreme cases where the first vaginoplasty has failed, a vaginal lining can be created from skin grafts from the thighs, or hips, or a section of the colon may be grafted (colovaginoplasty). These plastic surgeries need cosmetic refining to the outer vulva, which is not always done. Vaginoplasty in its sensational, functional and aesthetic result is fairly poor, about 20%.

It depends on the technique, the surgeon's skills, the elasticity and healing ability of the skin due to age, nutrition, smoking, physical inactivity, previous surgery in the area, nerve damage and blood loss during the operation. Post-operatively, it can be complicated by infection.

My feeling is, as human beings naturally desire happiness, pleasure and offspring, there will be no end to transition. It's for the medical profession to perfect it. There will always be womb donors as there are heart, liver and kidney donors.