A Space for Hermaphrodites (Hizra)

by Nirupoma Chowdhury and Sharif Atiqur Rahman

A few days back, we watched a movie. The villain was portrayed as a person with masculine attributes but dressed and behaved like a woman. In another movie a same kind of person played the role of a comedian. They are the “hermaphrodites”. In colloquial terms we call them “hizra”. In movies they are pictured as villains, comedians or “persona non grata”. In real life also they are isolated and neglected. Whenever we see them in the streets or markets or in any public place, we try to avoid them. Not only that, we stare at them with curiosity and at times, hatred. They are socially abandoned. But we must not forget that they are also humans and are very much a part of our society. Due to some natural reasons which are completely beyond their control, they do not belong to the normal or generally accepted gender division of humans. They are, in fact, physically handicapped human beings which prevents them from having an unambiguous gender identity. Most of us do not have the idea why they are hermaphrodites; what is their physical and mental structure; what is their life style and so on. We know nothing about the sorrows and agonies of their lives. In this write up an effort has been made to introduce these handicapped humans with the objective to create more acceptability within the society about the hermaphrodites and thus create a space for their just living.

Who are they?

Normal human cell contains 23 pairs of chromosomes. Of these, 22 pairs are called autosomes and the remaining one pair (two X in case of female or one X and one Y for male) is the sex chromosome. This pair of sex chromosomes determines the sex of the child. Sex chromosomes quite like the autosomes also carry genes that influence sexual differentiation by causing the bypotential gonad to develop either as a testis or as an ovary. Two normally functioning X chromosomes, in the absence of a Y chromosome and the genes for testicular organogenesis, lead to the formation of an ovary (female). The reverse situation (an X and a Y chromosome) lead to the development of a testis (male). This whole process of determining the sex of an embryo is done by some complex chemical reactions. The development of secondary sex symptoms (as for an example, beard for male and breast for female) are also conducted through a similar complex chemical synthesis involving genes, hormones and enzymes within the human body. Any disorder in the structure of the gene or abnormal hormone secretion or inborn error of hormone synthesis may result in the birth of a hermaphrodite (known as “hizra”). This can happen naturally without any reasonable explanation or because of gene mutation by radiation.

In medical science, this is termed as “ambiguous genitalia”. There are mainly two types of hermaphrodites. A true hermaphrodite is defined as a person who possesses both ovarian and testicular tissue. This is rarely seen. But pseudohermaphrodites are more common. A male pseudohermaphrodite is a person whose gonads are exclusively testis but whose genital organ exhibit incomplete masculinisation. In Bangladesh, this group of hermaphrodites is mostly found. On the other hand, a female pseudohermaphrodite is a person whose gonadal tissue is exclusively ovarian but whose genital development exhibits an ambiguous or male appearance.

In case of these pseudohermaphrodites, a boy child, mistakenly, starts to be socialised as a girl or vice versa. And here comes the term “psycho sex”. According to Dr. AKM Anwarul Islam (Urologist & Andrologist of Bangabandhu Shekh Mujib Medical University), studies of individuals who have been reared in the sex opposite to their chromosomal or gonadal sex, provide strong evidence that gender identity is not coded primarily by sex chromosomes. Rather it appears to be “imprinted” by words, attitudes and comparison of one’s body with those of others. This is what we call “psycho sex” or in other words, gender identity, defined as the identification of self as either male or female. Generally, gender identity agrees with the sex of assignment in the intersex patient, provided that the child is reared unambiguously and appropriate surgical and hormonal therapy is instituted, so that the child has an unambiguous male or female identity. Under these circumstances gender identity is usually established by 18-30 months of age. If, in puberty, discordant secondary sexual characteristics are allowed to develop and persist, some intersex patients develop doubts about their gender identity. This ultimately results into the transformation of a hermaphrodite.

Thus it becomes important to identify the true sex of a child immediately after birth. Any confusion has to be sorted out immediately so that the child can be brought up with an unambiguous gender identity.

Life and Living

We often find groups active protesting human rights violations. There are also groups who speak for the rights of the sex workers. But there is none to speak for these handicapped humans commonly known as “hizra” whose rights as human beings have always been violated. They are deprived of all sorts of civil and political rights. How painful and agonised the life and living of a hermaphrodite can be is beyond anyones imagination. We interviewed some of them to know more about their lives. At first they were suspicious about our motives. Then they asked as to what difference these writings would make for them. The struggle of their lives has made them suspicious about everything.

Hermaphrodites or “hizras” are rejected by their own families. Some of them were given away by their parents just after their birth. We have a common belief that whenever a child with ambiguous genitalia is born, “hizras” go there to take that child forcefully. It is true that they want to have that child with them, but it is also true that the parents do not hesitate to give away that child to them. They were brought up by other hermaphrodites. Some are driven away at their puberty when their discordant secondary sexual symptoms are exposed. Still many of them know where their family lives. Some of them at times go back to their parents, brothers and sisters. And at times they have even been cared as long as they have something to provide for the family. Then they are again harshly rejected.

According to the information provided by the hermaphrodites, they live in groups of four or five to protect themselves from social sufferings. The eldest one acts as the head of the group. They name themselves according to their perceived gender identity. They have sexual relationship among themselves. These groups are concentrated in certain areas and they are aware of other groups. They have leaders for each particular area. It seems that they obey their leaders with complete loyalty. Some of the hermaphrodites refused to talk to us without informing their leader. But they are not ready to expose their dwelling places.

The main source of earning of these hermaphrodites is prostitution. Normally they stay within their houses during the daytime. After the dark they gather in places where prostitutes are mostly seen. They suffer severe sexual harassment and exploitation. There are a lot of social activities to rehabilitate or to uphold the rights of female prostitutes. But nothing has been done for the hermaphrodites engaged in prostitution. We talked to some of the police members patrolling those areas who accused these “hizras” of snatching away money from lonely passers-by. The accused replied that they have to take recourse to such means only with their clients refusing to pay them. Another source of earning for these “hizras”, is toll collection from different markets of the city. They openly admitted that if the shop owners refuse to give them money, they start spoiling the commodities of the shop or create some obscene. Immediately the shop owner complies and fulfils their demand. These they have to do as nobody wants to employ them. In order to sustain their lives they have no other way but to take such disgraced ways of earning. But neither prostitution nor toll collection ensure them their basic necessities. There are many a days and nights which they have to spend without food.

Hermaphrodite expressed their frustration at the situation they face in public places. They are always treated as laughing stock. Since their childhood they experienced severe caustic comments. Without any reason people tease them, annoy them, and sometimes even abuse them physically. At times they are compelled to behave harshly and rudely due to complete insecurity.

Is it Curable?

Hermaphrodites are born due to some natural causes beyond the control of human beings. But if it is detected at early age, there is possibility of curing them.

Choice of Sex: The most important thing is to determine the sex of the new-born child. Determination of sex helps to create psychological and behavioural pattern. Concerned nurse-mother, doctor or the gynaecologist is the first person to identify the sex of the child. If there is any sort of ambiguity, a paediatrician or a urologist needs to be consulted immediately. In the management of a patient with ambiguous genitalia, at first a sex for rearing (that is most compatible with a well-adjusted life and sexual adequacy) will be diagnosed and then assigned. Once the sex for rearing is assigned, the gender role (those aspects of behaviour in which males and females differ from one another in our culture at this time) is reinforced by the use of appropriate surgical, hormonal or psychological measures.

Reassignment of Sex: Reassignment of sex in infancy and childhood is always a difficult psychological problem for the patient, the parents, and the physicians involved. While it is easier in infancy than after 2 years of age, it should always be taken with much deliberation and with provision for long-term medical and psychiatric supervision and counselling.

Reconstructive Surgery: Sometimes through some surgical measures, hermaphrodites can be turned into normal males or females. It is desirable to initiate plastic repairs of external genitalia prior to 6-12 months of age.

Hormonal Substitution Therapy: Development of primary and secondary sex organs can be influenced by hormonal substitution therapy. But this has to be done with utmost care.

Psychological Management: Sex is not a single biological entity but the summation of many morphological, functional and psychological potentialities. There must be no doubt in the mind of the parent or the child as to the child’s true sex. Chromosomal and gonadal sex are secondary matters; the sex of rearing is paramount. With proper surgical reconstruction and hormone substitution, the individual whose psychosexual gender is discordant with chromosomal gender, need not have any psychological catastrophe as long as the sex of rearing is accepted with conviction by the family and others during the critical early years.

Creating Space for the Hermaphrodites:

Some hermaphrodites are beyond any treatment. They have to live a life full of agonies, sufferings and tormentation. They are distressed in accepting the fact that they are not like normal human beings, and are sexually handicapped. Besides this, the anguish they suffer from the society makes it further unbearable for them. Society can play a vital role in reducing the sorrows of hermaphrodites. They want to work and earn their livelihood like others. The GOs and NGOs should come up with some income generating projects for them. Once they can earn their livelihood in a respectable manner, their social acceptability will increase. All of their basic rights have to be fulfilled. They have to be rehabilitated. Besides, we all should have the awareness that hermaphrodites are human beings as well. We should not alienate or abandon them from the society. Rather, if we try to accept them, the abnormalities they have in their behaviour will slowly be eradicated.

The authors are Faculty Member, School of English, Queens University and Research Internee, Centre for Alternatives respectively.