Editor’s note: In the wake of recent headlines around Anaya Bangar and Sanjay Bangar, conversations on gender-affirming surgeries have once again surfaced. But beyond the noise, these are deeply personal journeys. This weekend, we tell the story of Aarav, born female but identifying as male, tracing the emotional, medical and social realities of transition in India. As a reconstructive surgeon from Mumbai tells us, these stories must be told again and again. This is not for sensationalism, but for understanding, empathy and awareness in a society still catching up.
PS: We call him Aarav here, a name he chose to keep his story visible, but his life private.
For the first 22 years of his life, Aarav lived as someone the world insisted he was, a daughter, a girl, a name that never felt like his own. But internally, the dissonance was constant, exhausting, and deeply isolating. “I don’t remember a time when I felt like I was in the right body. As a child, I didn’t have the language for it. I just knew “kuch gadbad hai (something was off)”
Born to a middle-class family in Delhi NCR, Aarav grew up navigating a quiet but persistent discomfort. His father is a businessman, and his mother a software engineer who works in Gurgaon. It was never dramatic rebellion at home, just minor changes… refusing dresses, feeling alien in school spaces, withdrawing socially during adolescence…
Puberty, he recalls, was the breaking point. This is where it stopped being confusing and became distressing.
The transition that began
Aarav began researching gender identity seriously during college. What he found was both relieving and terrifying, a vocabulary that matched his experience, but also a long, uncertain road ahead.
In India, gender-affirming care is still emerging, but several hospitals and private clinics now offer structured pathways. Aarav eventually began his transition journey at a multidisciplinary gender clinic associated with a major private hospital in Mumbai.
Gender-affirming surgeries, he found, included top surgeries and bottom surgeries. “Transgender care is not a single speciality. It is a multidisciplinary approach. A transgender individual is assigned a team of doctors at the core of which consists of a psychiatrist, an endocrinologist, and a plastic surgeon,” says Dr. Ranjit Bhosale, senior consultant, plastic, aesthetic and reconstructive surgery, Sculpt Sublime, who has led teams performing gender-affirming procedures, though he was not involved in Aarav’s case.
Inside the medical procedure of gender-affirming surgeries
The process was neither quick nor was it a simple one for Aarav. “It wasn’t like you walk in and just ask for surgery. There were months of evaluation, therapy, and medical consultations before my case was even considered,” he recalls.
Medical frameworks like ICD and DSM guide such processes globally, ensuring that gender incongruence is assessed carefully over time. As Dr Bhosale explains, these evaluations are critical because surgical interventions, especially “bottom” surgeries, are irreversible.
According to the International Classification of Diseases (ICD), gender incongruence is assessed using three key criteria. First, the person has a strong desire to live and be accepted as a member of the opposite gender, often accompanied by a wish to align their body through hormone therapy or surgery.
Second, this identity must be persistent for at least two years. Third, it should not be explained by another mental health condition or chromosomal disorder. “Because gender-affirming surgeries are irreversible, individuals typically undergo careful psychological assessment over time to confirm that this identity is stable and not a temporary phase,” Dr. Bhosale explains.
Therefore, before any surgical step, Aarav underwent a detailed psychological assessment with counsellors trained in gender dysphoria. This phase, often called gender affirmation counselling, is critical, not to “approve” identity, but to ensure clarity, readiness and support.
| MYTH | REALITY |
|---|---|
| Surgery is the first step in transition. | Gender-affirming surgery usually comes after months or years of counselling, medical assessments, and hormone therapy. |
| Transition ends once surgery is done. | Surgery is only one stage. Follow-up care, therapy, and long-term medical monitoring continue afterward. |
| Gender-affirming surgery is a quick decision. | Doctors typically require psychological evaluation and sustained gender identity before considering surgery. |
| All transgender people undergo surgery. | Not everyone chooses surgery. Some people transition socially or medically without surgical procedures. |
| Gender-affirming surgery is purely cosmetic. | For many, it is a medically recognised treatment that helps reduce gender dysphoria and improve mental well-being. |
Aarav continues with his journey… “There were sessions where I had to unpack everything; right from my childhood, family, fears, to my expectations. It was emotionally draining, but also a necessary step.”
Following this came hormone therapy.
Under medical supervision, Aarav began testosterone treatment, a gradual process that began to align his physical traits with his identity. “Your voice changes, your body changes, but your mind takes time to catch up,” he says. “It’s not instant relief but a transition in every sense.”
Surgery came much later, after nearly a year of preparation. Aarav opted for top surgery (mastectomy), a common gender-affirming procedure for trans men. The surgery was performed in a private hospital in Mumbai by a team experienced in transgender healthcare.
Recovery after surgery
Recovery usually happens in two stages: immediate and long-term. The immediate phase focusses on healing of surgical wounds, as the stitches settle and the tissues strengthen.
“This initial healing process generally takes about six weeks. Long-term care is also important after gender-affirming surgery. In male-to-female procedures, the newly created vagina requires regular dilation and follow-up visits to ensure it remains open, healthy and comfortable,” Dr Bhosale explains.
In female-to-male procedures, the surgically created penis may require implants to enable erections, which also need routine medical check-ups to ensure they function properly.
The tough part: not physical but emotional
When asked about the biggest challenge, Aarav pauses and becomes emotional as he takes time to respond. “People think it’s surgery, but it’s not. It’s the loneliness before it which makes it impossible to bear. (Well, almost).”
The months leading up to transition were marked by intense anxiety. There was fear of judgment, fear of regret, fear of losing relationships.
“There were nights I would question everything. Not because I wasn’t sure of who I was, but because I was scared of what it would cost me,” he says.
Physically, the surgery was painful but manageable. Emotionally, however, the journey was far more complex. “There’s grief too because you are essentially letting go of a version of yourself that the world knew, even if it wasn’t real to you.”
The role of family
Aarav considers himself fortunate in one crucial way: his parents chose to stand by him.
“It didn’t happen overnight,” he says. “At first, there was denial, confusion, even silence.” His mother struggled the most initially, Aarav recalls. “She kept asking, ‘Why didn’t you tell us earlier?’ It took time for her to understand that I didn’t have the words back then.”
What changed things was counselling. Aarav’s parents were encouraged to attend family sessions with therapists, where they could ask questions, express fears, and gradually come to terms with his identity.
“My father said something I will never forget. He told me, ‘I may not understand everything, but I don’t want to lose my child.’” That moment, he says, made the rest of the journey survivable.
Post surgery: recovery and reality
Post-surgery care was structured and demanding. Aarav spent several weeks in recovery, with strict instructions on movement, hygiene, and wound care. Follow-up consultations were frequent, ensuring healing was on track. “There’s a misconception that surgery is the end. It’s actually the beginning of a new phase,” he says.
There were physical discomforts, including restricted movement, pain, and fatigue, but also a quiet, growing sense of alignment. “The first time I looked at myself after healing, I didn’t feel shock. I felt calm.”
If the medical journey was structured, the social one was anything but. Returning to everyday life brought a different kind of challenge, navigating people’s reactions was one of the worst challenges. “There were questions, stares, whispers… Some people were curious, some were insensitive, some just didn’t know how to behave,” he recalls.
Workspaces, extended family, even old friends required explanation, patience and, at times, distance. “In the beginning, it felt like I had to justify my existence. That was exhausting,” he added.
But over time, things shifted. “You realise you don’t owe everyone an explanation. You choose your circle.”
Healing not linear
Even after the transition, Aarav says, the emotional journey continues. “There’s relief, yes. But there’s also trauma you carry, including years of hiding, confusion, and fear.” Therapy remains a constant in his life, not as a necessity, but as support. “I don’t think transition erases the past. It just allows you to finally process it.”
Today, at 32, Aarav describes his life as “quietly normal;” a phrase that carries more meaning than it appears. He is the owner of a reputed skincare clinic with 38 centres across India (as franchises). He has a small but supportive circle of friends, and a relationship with his parents that is stronger than before.
There is no dramatic ‘after’ moment. Life doesn’t suddenly become perfect. But it becomes yours.
And this, he believes, is everything.
Last but not the least
Gender-affirming care in India is still evolving, and awareness remains uneven. Each individual case is bespoke work. It is not a one-size fits all process. Every individual is different. Factors such as immunity, overall health, body structure, and even day-to-day conditions can influence how a medical procedure is performed, which is why doctors often adjust their approach for each patient, Dr. Bhosale highlights.
For many, like Aarav, the journey is not just medical, but deeply social and emotional. “People think this is a choice. I would like to tell them that it is not. The choice is whether to live truthfully or continue pretending.”
For him, the answer was clear, even if the path wasn’t (at that point).
I didn’t become someone new. I just stopped being someone I wasn’t
(Aside from the quoted inputs, we thank Dr Bhosale for his guidance in helping shape this story.)
– Ends
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