RAWALPINDI: Though his family feels stronger at the addition of another male member in him, teenager Abdul Raheem is fighting an identity crisis lying in the Pakistan Railways Hospital in the city.

“I am a male now after undergoing surgery of my ambiguous genitalia. But how to explain the change to the people who had known me as Rubina all these years,” the 16-year-old told Dawn, writhing in his hospital bed at their jibes and mischievous looks at his makeover.

Nevertheless, the new ‘family man’ from Chichawatni is excited about the life ahead.

“I have long desired education and you know girls of poor families rarely get that chance in our conservative society. So changing into a man, will, hopefully, make that prospect a little easier to me,” he said.

Interestingly, Raheem is the second in the family to undergo sex change.

His elder sister Samina underwent the same surgical procedure in the same hospital in 2006 and emerged as Shaheer Abbas. Rubina turned into Abdul Raheem.

“When she reached adulthood, she felt severe pain. A lady doctor in Cheechawatni saw signs of sex change in her and, like Samina, we brought her here,” said Zaheer Abbas, their only natural brother.

“Previously, we were three sisters and one brother. Now the equation has changed into three brothers and one sister,” he said chuckling.

“Shaheer, formerly Samina, runs a bakery and is getting married next month.”

Zaheer Abbas is confident that Abdul Raheem will overcome his identity crisis “and settle like Shaheer who runs a bakery and is getting married next month”.

However, Associate Professor Dr Ahmed Rehman of the Urology Department of Pakistan Railways Hospital says doctors cannot change the sex of a person.

“One is born male or female,” he told Dawn. But, sometimes, genetic problems and hormone imbalance hide the genitals and doctors just operate and uncover them.”

“The family brought Rubina to us when she did not show signs of developing into a woman. Pathological tests showed that the patient was a male and needed surgical procedure to restore his original identity,” he said.

In recent years, many such cases were brought to the hospital. “There is need to understand the identity of gender in such cases.

Doctors can tell parents that soon after the birth of their child and early surgery would avoid unnecessary identity crisis,” said Prof Dr Rehman.

What such patients needed most, however, was understanding, support and sympathy of the family and acquaintances.

Dr Rehman said that generally, a boy-turned-girl did not need plastic surgery post sex change.

“Cases which require plastic surgery are rare,” he said.

Dr Afzal Farooqi, former principal of Rawalpindi Medical College and Professor of Urology, agreed that ambiguous genitalia cases, where sex of the baby could not be defined because the male organ grew inside and is not visible and it grew inside gradually, are very rare.