Born in a modest household in Janakpur, Asmit (name changed) was assigned male at birth. But from a young age, Asmit’s inner world told a different story — one of femininity, identity, and misalignment between body and soul. While others saw a boy, Asmit felt, dreamed, and expressed herself like a girl. Her preferences, playmates, attire, and demeanor all reflected her inner truth.
“I always felt different,” Asmit once told her doctor. “But my body and society kept insisting I was a boy.”
As puberty progressed, the distress deepened. The development of typically male physical traits — facial hair, a deep voice, and the absence of breast development — caused immense mental anguish. At home and in society, she was treated as a male. No one recognised or accepted her internal identity.
With mounting pressure to behave like a “boy,” Asmit made the difficult decision to leave her family and forge her own path. Choosing authenticity over comfort, she sought help from the Blue Diamond Society, an organisation advocating for LGBTQ+ rights in Nepal. It was the beginning of a new chapter — a journey towards becoming Asmita.
In March, Asmit connected with doctors at Tribhuvan University Teaching Hospital (TUTH). For the first time in Nepal’s medical history, the hospital was preparing for gender-affirming surgery — a procedure to transform male genitalia into female anatomy.
This was a ray of hope for Asmit.
After comprehensive psychological evaluations and medical assessments by a team of psychiatrists, hormone specialists, plastic surgeons, and surgeons, she was approved for surgery. On May 27, Nepal successfully performed its first male-to-female sex reassignment surgery.
Following the surgery, Asmit embraced her new identity: Asmita. “For the first time in my life, I feel like my body truly belongs to me,” she said.
Though the physical transformation is complete, Asmita’s journey is far from over. Challenges remain — from social acceptance to employment opportunities. Still, her successful surgery marks a historic step for transgender rights in Nepal.
“This surgery has given hope to many others like me,” Asmita said. “We exist, and we deserve a life of dignity.”
How the surgery was made possible
The idea to perform gender-affirming surgery at TUTH had been in development for over a year. Discussions had been ongoing with Dr Alireza Hamidian Jaromi, a plastic and gender-affirming surgeon based in the United States, who has over six years of experience in transgender healthcare.
Nepali doctors collaborated with the Blue Diamond Society to identify potential candidates. Among those who came forward, Asmit was one. After preliminary screenings and confirmation of her transgender identity, the medical team began preparations.
According to Dr Jaynaman Shrestha, head of the Department of Plastic Surgery, every aspect of Asmit’s mental, emotional, and physical well-being was thoroughly evaluated. The process followed international protocols, including the World Professional Association for Transgender Health (WPATH) Standards of Care.
Key requirements included: living as one’s identified gender for at least one year, being over 18 years of age and undergoing hormone therapy for a prescribed period and experiencing psychological readiness.
Once all conditions were met, the surgical team proceeded. The six-hour surgery involved careful reconstruction, including preserving the glans penis (to form the clitoris) and rebuilding the urinary tract. Non-essential tissues were removed, while useful nerve-rich structures were preserved to maintain sensitivity and function.
Due to the surgery’s complexity and its being the first of its kind in Nepal, a foreign specialist was also involved. But Dr Shrestha stressed that Nepali doctors are fully capable of performing such operations. “Technically, we are equipped. We’ve been performing complex surgeries like this already,” he said.
The medical team has proposed that such surgeries be made routine under a specialised “Gender-Affirming Clinic” — with legal clarity and institutional support.
Cost and legal ambiguities
The surgery cost approximately Rs 150,000 to Rs 200,000 — a fraction of what it would cost abroad (typically Rs 2.5 to Rs 3 million in India or Thailand). The affordability could significantly increase access for Nepal’s transgender population.
However, doctors emphasised the need for legal reform to ease the medical process. Currently, the absence of legal clarity may put both patients and doctors in uncertain positions.
“This is a medical condition — not a disease, but it requires medical intervention,” said Dr Shrestha. “Therefore, legal procedures must be made simpler to support these individuals.”
He urged transgender communities to advocate for legal recognition and institutional changes to ensure the sustainability of such medical services.
A new dawn for transgender healthcare
According to the 2021 national census, 2,928 people in Nepal identify as part of sexual and gender minority communities — roughly 0.01% of the population. Of these, over 32% live in Bagmati Province.
Until now, transgender individuals seeking gender-affirming surgery had to travel abroad, incurring heavy financial and emotional burdens. Asmita’s successful surgery at TUTH not only provides medical relief but also symbolises growing recognition and acceptance.
Yunisha Pandey, President of the Blue Diamond Society, expressed gratitude: “Before, people had to spend up to two million rupees for surgery abroad. Now, they can access it at home. This brings immense relief.”
Several individuals have already expressed interest in undergoing similar surgeries.
The hospital has announced plans to establish a permanent Gender-Affirming Clinic to offer ongoing services.
Recognising the inner truth from childhood
Doctors note that transgender individuals often become aware of their gender identity at an early age. “Most begin to feel different by the age of 10 or 11,” said Dr Shrestha. “Their behaviours, clothing preferences, and overall presentation begin to reflect that.”
However, societal resistance can be strong. Families may initially ignore such signs, but as the behavior persists, pressure builds. Many transgender individuals eventually leave their families to seek acceptance elsewhere.
Despite the social challenges, medical intervention can be a turning point. “Only after overcoming these hurdles do many get the chance to fully embrace themselves,” said Dr Shrestha.
Asmita’s story is not just one of medical success — it is a landmark moment for dignity, rights, and hope in Nepal’s transgender movement.
