Conservative discourse in Pakistan relies on a fundamental misunderstanding of gender identity.
The word “intersex” has recently garnered much attention in contemporary online and offline discussions in Pakistan. It is unfortunate, however, that this word was brought into the discourse largely by a group of upper-class, conservative social media personalities who have foregrounded this term to delegitimize the use of the more broader term “transgender.” They have sought to divide transgender people into two categories: “real” intersex people who were born with sex-related birth anomalies and “fake” transgender people who pretend to be the gender they were not born as.
In 2018, Pakistan earned global commendations for passing “one of the world’s most progressive trans rights bills.” It was a victory march. All of Pakistan’s citizens who did not identify or live as cisgender males or females finally had the right to self-identify their gender on official documentation, and thus access the right to vote, run for office, inherit property, and be protected from socioeconomic discrimination.
While deviance from globalized gender norms was not uncommon in Pakistan, these legal developments brought some common but often unexplored inquiries into the limelight. Who is a transgender person? How are they different from intersex people? Do these communities fall under the umbrella of the LGBTQ acronym, given all the political connotations associated with it? Are people from both of these categories to be protected or feared? And most importantly, are these people worth fighting for in a country like Pakistan, where troubles of ostensibly much greater priority remain unresolved?
Learning about the real experiences of transgender and intersex people from Pakistan – who are by no means a monolith – can provide this much needed clarity. I say this with a lot of confidence because most transgender and intersex people spend lives that inherently defy and challenge the sociological, political and even medical labels that exist to understand them. It is redundant, at this point, to note that these aforementioned labels and their preceding structures of knowledge are tied closely to the practical history of colonialism, the globalization of industrial capitalism, and modernity.
What does the science say?
In contemporary medicine, it is widely understood that intersex variations can exist on the genital, physiological, chromosomal, hormonal, psychological, and neurological levels.
Only the first two of these levels may be visible to the naked eye. Simultaneously, the fourth and fifth level stated above may be transformed (or brutalized) by physiological conformity to the gender binary through focused schooling and other techniques of controlling human behavior. Save from a few mildly conclusive studies on trends within the brain scans of transgender and intersex individuals before and on Gender Affirmative Hormone Therapy (GAHT), it is very rare, if not impossible, to identify or predict intersex variation on the basis of neurological testing. Chromosomal intersex variations, on the other hand, have recently become diagnosable through the advent of commercial chromosomal karyotyping in testing laboratories. I got mine done from Chughtai Lab in Clifton, Karachi.
Hormonal variations are commonplace and are often treated as health conditions that must be corrected in the most feasible direction within the gender binary. This decision is often made independently by doctors, and other times, with the consultation of concerned parents. Gynecomastia, for example, is a common condition in which male children develop breast gland tissue. Most people opt to surgically remove these breasts. Pakistan also reports a high incident rate of Androgen Insensitivity Syndrome (AIS), which the Aga Khan University Hospital describes as “when a person is genetically a male but has the physical appearance of a female.” In 2020, the Pakistan Armed Forces Medical Journal released a report titled “Gender Assignment In Complete Androgen Insensitivity Syndrome: Who Should Be The Decision Maker” in which they report on “very rare case of 10-year old phenotypic female who presented in outpatient department with bilateral inguinal hernia” and turned out to be a patient of complete androgen insensitivity syndrome. Even the scientific work of the often ideologically motivated Pakistan Armed Forces does not deny the reality of intersex people, of variations beyond genital and physiological levels.
The medical industry has dealt with the intersex “issue,” especially at the genital and physiological level, for a long time. Statistically, 1.7% of all births in the population are considered to be of the intersex variety. Some of these include people born with ambiguous genitalia and some are people born with other conditions that involve the development of atypical chromosomes, gonads or hormones. Across the world, the natural birth process of these 1.7% births is interrupted by medical professionals who perform sexually corrective surgeries to help atypical children fit into the world as either male or female. In many cases, those who undergo corrective surgeries denounce the actions performed on them as medical overreach.
Cathren Cohen of the National Health Law Program explains: “[w]hile some intersex conditions can present issues making or regulating hormones or can carry other health risks, for the vast majority of intersex infants, surgical intervention is not medically necessary. Rather, intersex surgeries — most of which are done when children are under 2 years old — can create life-long harms. These surgeries can result in scarring, chronic pain, chronic incontinence, loss of sexual sensation, sterilization, inaccurate gender assignment, and trauma.”
In recognition of the harm associated with these “corrective” surgeries, intersex activists in the U.S. released an official policy guide for hospitals that called for the delay in any corrective surgery until the intersex child is old enough to consent.
A beautiful juxtaposition in this regard is what happens when intersex or transgender persons (of any variety) consent to gender-affirmative treatment, including surgeries. In a 2022 systematic medical review and meta-analysis, published by the National Institute of Health in the U.S., it was reported that the “prevalence of regret among patients undergoing transmasculine and transfeminine surgeries was <1%.” Better yet, the largest peer-reviewed study on GAHT arrived at this conclusion: “the use of gender-affirming hormone therapy (GAHT) is significantly related to lower rates of depression, suicidal ideation and suicide attempts among transgender and nonbinary youth.”
Consent, in this case, is not only sexy. It is life-affirming and, as a result, life saving.
Let me illustrate this idea with an example.
Living a transgendered life
My most intimate observation of life spent transgendered in Pakistan is my own.
After spending almost 26 years in utter confusion about my internal sense of self and my resulting place in society, I was diagnosed with a chromosomal intersex variation last year. There had always been various signs that, though assigned male at birth, I was not like typical boys or men in my behavior and biology. Reflecting on this now, it is shocking that despite my many privileges, it took me 26 years to see the doctor about an issue I knew I was having since I was very young.
What is my transgendered life experience? Clinically speaking, first I was assigned male at birth due to apparent genitalia. There were celebrations surrounding the maleness of my birth; my mother tells me that it was the first time my father took special interest in the announcement of a birth and its ensuing infant care. She believed my birth tipped the scales in her favor, in terms of matrimonial privilege. As a second wife, she was ousted from the wealth, support and community of my father’s elite family. She had given him, before me, one son and one daughter. So had my father’s first wife. My arrival put my mother in a privileged position.
Often, in lengthy discussions about the spiritual dimensions behind my gender identity, she bemoans that she had broken a rule while praying for me. Her rocky marriage with my father had inspired her to seek the support of a pir to ask (nay, demand) God for a male child. She had conducted this exercise for my older brother. When there was a fight at home at the time she was 4 months pregnant with me, even though the pir had warned her that spiritual sway requires divine permission, she started reciting the special prayer he had given her earlier.
She has often wondered: is that why God punished my child?
The fights at home were awful; witnessing them is the origin story of my own feminism. I frequently wonder at the tragedy of that night, when my mother – lover of all things feminine – tore up and begged God for another male child. The woman had already birthed two daughters to no jubilations. Something biological in her must have wanted to survive, must have wanted her kin to survive. And alas: when her second son came into the world, her conflicted husband decided to commit to his new family, and moved in with my mother permanently. I was 5 years old, when he became the first person to ever witness me cross-dressing. By then, I was already singing English pop songs, and performing item numbers to “Zara Zara Touch Me” on Eid for the whole family. I used to earn PKR 100 per family member, and my earnings would take me and my cousins to the King & Queens pizza parlour in Faisal Town.
By my teenage years, I embraced the LGBTQ umbrella and came out as a “bisexual” male. I was already halfway through my 12-year-sentence at the ultra-masculine Aitchison College. At the time, sexuality, not gender, was the one framework available to me to understand my identity, my desires, hopes, and affinities.
I had come out as bisexual for reasons of safety. I’m only a little different, I asserted. By the end of high school, I was over pretending to be interested in girls in the same way as I was interested in boys so the announcement changed: I am the gayest person in the world. Even at that time, however, it was not lost on me that my declarations of identity were the announcements of a little kid learning how to survive his (her) political reality. Internally, I knew that the narratives I announced publicly while living in Pakistan were different from the narratives that existed internally.
At the age of 12, my best friend and I confessed our cowardice to one another in a joke. We claimed, over gagged laughter, that all “bottoms” were really just trans girls who did not have the courage to reveal their inner selves to the world. Perhaps this is generally untrue, but it was our truth and so we declared it as a maxim. It was also our shared knowledge that we both felt the same way. I was just a girl. We were just girls.
A decade and a half later, when I told my mother that I was going to medically transition into a woman, she was very concerned for my health. She thought I was “healthy” and that it would be a risky decision to make. I saw her point of view; and I told my Mummy that though this was a hard decision I wished I did not have to make, I had no other choice. I was going to consult a specialist and get a medical opinion. Despite my many monetary and academic successes, I was living as a man in anguish at the fact of my perceived manhood. With age, it was becoming hard to deny that this inner conflict had manifested in external conflicts with the world several times. At 26, I was devastated by the loop I was stuck in: aim for heaven, find myself in a world where my soul and body were in dissonance, and subsequently blame my various paradises and their respective Beloveds for not being accepting enough. It took me a quarter-life crisis but I finally realized I was projecting my inner reality onto unsuspecting Edens and clueless boys. In fact, I did not accept myself as a trans person, and I believed my detractors on some level: sure, I want to be something I seem to not be. There was also quite a lot of romance in the idea of rejecting pharmaceutical assistance. I wanted to be au naturale, just how God made me.
My only political mistake is that I also want(ed) the total height and breadth of my inalienable human rights, at my place of origin, and in the language of my ancestors. The alternative (promoted by pinkwashing campaigns run by Global North economies and fringe states like Israel) is to buy in to settler colonialism. The buy-in is usually supplemented by an arduous immigration process which is likely to include strict models of self-representations for queer people to process legal documents successfully. In “Becoming an ‘Authentic’ SOGI Refugee’ from Real Queer, David A.B. Murray extensively analyses how queer Global Southerners are routinely subjected to various forms of symbolic violence and legal coercion necessitated by the imperial immigration apparati which relies heavily on a document called the “personal narrative” as an evidentiary document. Murray further contextualizes this violence as requiring applicants to present a “reified version of their country of origin’s national culture that is cast in racialized, colonialist terms” while imposing a “prism of assumed understandings of ‘real’ or authentic gay, lesbian, bisexual or transgendered identities.”
In the spring of 2018, I was educated in these topics and their repercussions on queer lives under the guidance of Graeme Reid, then-Director of Lesbian, Gay, Bisexual, and Transgender Rights Program at the Human Rights Watch. On April 12th, I responded to Murray’s insights with a few declarations fuelled by my simultaneous study in postcolonial theory and literature:
“If your liberation asks me to tape my beautiful, brown body under the sick formulas of your capitalist, colonial gold – I don’t want it. I don’t want it, I don’t want it.”
“Raise your hands if the future of your queer liberation doesn’t look like America’s iteration of it.”
In retrospect, I recognize that to even think in such a way is a privilege afforded to very few in the world. I was only to later realize that state-backed marginalization truly puts you in the margins of life. My class position had allowed me a lot of freedom in Pakistan, and also made me an ambitious person. But as an adult, I realized that my metastasizing queerness meant I would be forcibly kept on the outs of institutional support, the kindness of many strangers, and even visibility in the space of leftist or traditional politics. Even the most progressive factions of society look at transgender persons with skepticism. This is especially the case if the transgender person in question is one of white-collar volition or is unfortunately yet to be silenced by Pakistan’s ruthlessly unforgiving class structure. Instead of decree or unfortunate fate, it is the transgender person’s right to choice that we embody in our literacy, and patriarchal society obviously resists this offense to its rigid enforcement of heterosexuality.
To be real in an artificial nation
In Pakistan, the folklore surrounding the existence of transgender people is the following simple story: some kids are born so differently that they are neither male nor female, and as a result, they are either abducted by or given for their upbringing to existing transgender communities, known as “khwajasiras” or “hijras.” Within these communities, networks of kinship and patronage are established to raise the younger members of the community. Gharanas, qabeelas or Guru-chela lineages are some ways and monikers for these “chosen”-family structures that shelter South Asia’s transgender people. Some members join this community at birth. These are usually intersex folks. Many run away from their homes and join as adolescents or young adults. These are people who would usually go by the title of a “transgender” person.
Today, these communities post dance videos on Instagram and crowd around vehicles at traffic signals for alms. They still frequent wedding functions in towns big or small to give their blessings. I am sure that many Pakistani mothers still explain to their young children that these people of the third gender are God’s special, gifted people and we should give them the utmost respect. I am also sure that these people pity transgender persons that they see on the street and hope that their loved ones are never afflicted in a similar way.
However, there remains still a well-established history of transgendered life experiences in the Indian subcontinent that is even more complicated than these reductive, simplistic narratives. For example, the stories of Sufi spiritual masters had dominated my own Pakistani zeitgeist, especially in opposition to the rising forces of Islamic conservatism and militarism in the country. And these stories, they were ornate! Bulleh Shah had allegedly spent 12 years as a “dancing girl” to win back favor from his spiritual guide Shah Inayat, who Bulleh Shah had once erroneously rejected due to familial pressure based on Shah Inayat’s “low-caste.” The legend goes that transgender community members performed Bulleh Shah’s funeral rites when the clergy declared him an infidel. Today, his shrine – a mere 30 minutes away from my home – is a hotspot for spiritual journeyers from across the world. Bulleh Shah was also, like many others, not the only one. From the vantage point of my urbanized life in Lahore, nurtured through cursory nostalgia for the Sufi roots of the modern subcontinent and a Punjabi slang that was definitely sex-obsessed if not sex-positive, the homoerotics of life were omnipresent.
Pakistan’s folklore about trans people is not entirely inaccurate but it is quite strategic. It gives just enough information to explain the existence of transgender persons in society without necessarily helping society understand them – how they come into being, how they choose to decorate their being. Discussion over specific cultural elements of Pakistan’s indigenous transgender communities are outside the scope of this article; I have also chosen to write about transgendered life through a culturally universal lens as it is my hope to use this article to dispel any myths surrounding the science and nature of transgendered living.
I believe that living a transgendered life publicly serves as a gateway to the obliteration of the oppressive sexual and moral code propagated in society through its most powerful elements (usually, the church and the state). Trans people embody, often extremely, the age-old practice of defying cultural norms on gender roles. Women who choose to not give birth, women who are unable to give birth, women who grow moustaches naturally, or women who are severely disaffected towards historically feminine behaviors or proclivities are all people who are affected by social practices or beliefs that discriminate against transgender persons.
So if one may be confused as to why transgender people have been systematically misrepresented, erased and oppressed, I believe the answer may lie in the fact that a trans person is a threat to the fabric of the modern nation-state, which depends on normative gender roles’ multidimensionally damaging political reality. Now, a trans person who can speak for themselves, write against dishonesty and resists imposed death? That’s a whole other story – one our ancestors have written Sufi legends about.
Gender today is a tremendous problem globally and locally. It was mine from the day I was born, but it especially became a daily challenge when I was enrolled in an all-boys school where it was demanded of me to exist in the confines of an emotionally-caging, patriarchal and colonial idea of appropriate conduct for ‘boys.’
The Pakistani taboo that my life has become is that I resisted these confines. It makes it worse that, with the grace of God, I believe I resisted them quite successfully.
Today, I am visibly just an average transgender person. Other trans people will look at me and smile kindly for they perceive me to be a “baby trans.” If someone asks, I can inform them that I am intersex because I have the medical diagnosis to back up that claim. Trans people generally do not ask this question of one another out of sheer disinterest in the medical classification of transgendered bodies. For the right reasons, too, since I have been the same person with the same desires before and after my medical diagnosis. I have one thing to say to the world about my identity: stigma and socialization be damned, I am just a girl. I am even happy to concede that I am anything but a boy or a man. I am even happier to concede that I am, or I desire to be, more like the girls are than like the boys are. In fact, as I was studying classical music in an all-boys batch at Pakistan’s premier and national academy of the performing arts, it gave me great pride to remind myself that I was the closest thing that class has to a woman.
In short: I am an intersex person who figured out the “rare,” stigmatized medical condition I had due to the educational opportunities I was offered. Many trans people arrive at figuring out who they are and how they should appear merely on a very strong belief in how they feel. I respect them, and their faith, a lot more than my own. I wish I had been brave enough to announce that I am a girl and I want to be like the girls much earlier on. Instead, I wanted to make my Mummy proud and succeed at the world, at all costs. So I learned the manners of the patriarchy and how to access power within it. I even shared them with all my girlfriends.
As we, together, survive our homeland in ways novel and technological,
We rewrite the Pakistani story with our own blood and guts –
Which is to say:
An age has passed, since Mansur’s “An Al Haq”
I am here to give fresh lustre to the gallows
– Sarmad Shaheed
Zara, formerly known as Zulfi, is a writer and musician, based in Karachi and originally from Lahore, Pakistan. She is also the co-founder of the Kitab Ghar public library movement.
