In a recent podcast, Noor Shekhawat, a proud trans woman and activist, shared deep insights about the gender transition process in India. Drawing from her personal journey and experiences, she explained what transgender individuals go through when opting for Sexual Reassignment Surgery (SRS), also called Gender Affirmation Surgery.
Her story gives us a real look into the steps, costs, risks, and social challenges of transition. Here’s a simplified version of what Noor shared.
1. What is SRS (Sexual Reassignment Surgery)?
According to Noor, SRS is not just one surgery but a series of medical and emotional steps. It helps transgender people align their physical body with their gender identity. Importantly, once done, SRS is not reversible.
2. The Step-by-Step Process (as explained by Noor)
- Counseling & Psychiatric Evaluation
- The first step is meeting a psychiatrist.
- Multiple counseling sessions (over 6–12 months or more) are required.
- Purpose: To ensure the person is genuinely ready, not influenced by others, and aware of lifelong consequences.
- At the end, the psychiatrist issues a Gender Identity Dysphoria (GID) certificate.
- Hormone Therapy
- Next comes hormone replacement therapy (HRT), prescribed by an endocrinologist.
- Hormones slowly change the body (skin, hair, fat distribution, and voice).
- This lasts for 2–3 years before surgery.
- Surgery
- Finally, the surgeon explains all risks and benefits.
- Consent is crucial because it is a life-threatening and irreversible step.
- Surgeries include:
- Top Surgery – Breast implants (for trans women) or breast removal (for trans men).
- Bottom Surgery – Various methods to reconstruct genitals.
3. Types of Bottom Surgery for Trans Women (Noor’s Insights)
- Basic Vaginal Creation – Only for urination, no intimacy.
- Penile Inversion – Uses penis skin to create depth (2–3 inches).
- Peritoneal Vaginoplasty – Uses abdominal lining for 6–7 inches depth, but requires care.
- Sigmoid Colon Vaginoplasty – Uses large intestine for 10–12 inches depth, allows lubrication, and is most successful.
Noor herself underwent the sigmoid colon method, which involved a team of five doctors.
4. Cost of Transition in India
Noor openly shared that her own transition cost her ₹10–15 lakhs over a period of 4–5 years, including counseling, hormone therapy, and surgeries.
Here’s a general breakdown:
- Top Surgery: ₹90,000 – ₹2.5 lakhs
- Bottom Surgery: ₹2 lakhs – ₹10 lakhs (depending on method)
- Hormones, Tests & Counseling: ₹2–4 lakhs
5. Government Support
- The Department of Social Justice currently provides ₹5 lakh assistance for transgender individuals opting for surgery.
- However, Noor highlighted that this is not enough since real costs are much higher.
6. Risks and Challenges
Noor emphasized that transition is not only about money or medical steps, but also about mental and social challenges:
- Medical Risks: Complications under anesthesia, hidden health issues (like epilepsy) can be fatal.
- Emotional Risks: Once surgery is done, there is no going back. Some people regret it later if they lose family or social support.
- Social Struggles: Even after transition, acceptance in society remains difficult.
This is why Noor stressed the importance of long counseling sessions before surgery.
7. Life After Surgery
Noor shared that after her surgery:
- Her skin became softer.
- Hair texture and growth changed.
- Her voice shifted slightly.
- Intimacy is possible with advanced surgeries like sigmoid colon vaginoplasty.
However, she clarified that trans women cannot conceive children (due to lack of uterus), and trans men cannot produce sperm. Biological reproduction is not possible.
Conclusion
From Noor Shekhawat’s journey, it’s clear that gender transition is not a single operation but a long, 4–5 year process involving counseling, hormones, multiple surgeries, and heavy costs.
For many like Noor, despite the pain and expense, the process brings dignity, self-acceptance, and the ability to live authentically.

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