In The Danish Girl, we learn of the story of Lili Elbe, said to be the first recipient of gender reassignment surgery sometime in 1930. Originally Einar Wegener, a prolific Danish landscape painter, she felt that she had been born into the wrong body and found salvation in Kurt Warnekros, a surgeon who would perform the life-changing operation for her in Dresden, Germany.

The story of Elbe is considered groundbreaking and a revelation to those studying sexology, but do you know that Singapore had our own Lili in the 1960s? The successful procedure was what paved the way for Singapore to become a hub for sex change operations in the 1970s and 1980s.

But first, I bet you want to find out more about the Singapore Lili.

Elbe/Wegener is played by Eddie Redmayne (nominated for Best Actor for this year's Academy Awards), whose portrayal of Lili - with short auburn waves and a simpering smile - will probably be remembered as Hollywood's tribute to the transgender community for a long time to come.

Elbe/Wegener is played by Eddie Redmayne (nominated for Best Actor for this year’s Academy Awards), whose portrayal of Lili – with short auburn waves and a simpering smile – will probably be remembered as Hollywood’s tribute to the transgender community for a long time to come.

Her name is not publicised, but Infopedia tells us that she was a 24-year-old Chinese man who was known as “Mama Chan” (note: no relation to the author) when she became a cabaret girl. The patient came from a troubled background: She had a violent father and was brought up by her grandmother, who dressed her as a girl. As a teen, she would associate with cross-dressers and when she reached adulthood, would go frequenting the transsexual and transvestite scene in Bugis Street.

From the time she was 16, she worked as a sales assistant, a housemaid, in a bank and a public relations. She was also a beauty queen – she won the second prize in a pageant and became a part-time model. She joined a cabaret and that’s where she got her nickname, and also ran a social escort service.

Living a woman’s life in a man’s body came with its baggage: Mama Chan suffered sexual and emotional problems, which led to two suicide attempts. In 1969, she consulted Professor S.S. Ratnam, a senior lecturer in the University of Singapore’s Department of Obstetrics and Gynaecology. Prof Ratnam explained that he had no experience in sex change surgery, but she continued to visit his clinic weekly. After researching the subject of transsexualism and sex reassignment surgeries, Prof Ratnam familiarised himself with the surgical techniques by practising on cadavers.

Einar Wegener's awakening came by chance, when he was asked to pose as a female model for his wife Gerda. Credit: Universal Pictures

Einar Wegener’s awakening came by chance, when he was asked to pose as a female model for his wife Gerda. Credit: Universal Pictures

In The Danish Girl, you’d see Elbe seek psychological help from various doctors, one which even diagnosed her as schizophrenic and tried to lock her up as a mental patient. Mama Chan had to undergo psychological analysis by a team of psychiatrists as well. Thankfully for her, they confirmed that she was a transsexual who required surgery. The patient was cautioned that the surgery would be irreversible, potentially involved a number of complications and would require a prolonged follow-up period.

The hospital sought legal clearance for the operation from the Ministry of Health, which granted approval. And this was how Mama Chan became the first recipient of sex change surgery at the KK Women and Children’s Hospital (then simply known as Kandang Kerbau Hospital) on July 30, 1971.

The three-hour operation was performed by Prof Ratnam and two other surgeons from the University of Singapore’s Department of Obstetrics and Gynaecology, Associate Professor Khew Khoon Shin and plastic surgeon R. Sundarason.

In an interview with Dr Sundarason, he revealed that prior to the op, the patient had been taking oestrogens for about four years and dressed up as a woman for 12.

A two-page paper co-written by Prof Ratnam and Dr Sundarason details: “The breasts were reasonably well-developed and the distribution of body hair and fat was that of a female. Despite this, the patient was determined to end his life unless the male genitalia were removed. At this stage, he was not concerned about a vagina.”

Gerda and Lili continued sharing a bed as friends. Credit: Universal Pictures

Gerda and Lili continued sharing a bed as friends. Credit: Universal Pictures

It was Dr Sundarason’s first time conducting such an operation as well, only having been trained by “a chap (a plastic surgeon by the name of Gerry Moore) who was interested in it” at East Grinstead in Britain. He and Prof Ratnam fine-tuned Moore’s technique and probably exceeded the patient’s expectations, for they did create a vagina for the patient. Dr Sunda made use of the tube of penile skin, which functions as a pedicle graft, to line the artificial vagina.

The endeavour was a success, with an uneventful post-surgery recovery. Prof Ratnam later founded the Gender Identity Clinic specialising in sex change surgeries at the National University Hospital, and his research work helped place Singapore in the international medical arena. In the 1980s, he went on to found the in-vitro fertilisation (IVF) programme in Singapore. A few years before his death in 2001, he was appointed Emeritus Professor at the National University of Singapore.

Okay, enough about Prof Ratnam – what about Mama Chan?

After her successful operation, she went on hormone treatments and was functionally a woman, with the exception of being unable to conceive or menstruate. She later married a French man and ran a travel agency in Paris, before moving to England. (By the way, if you must know, by 1973, the Singapore Government allowed sex change patients to have their new sex reflected on their identity cards; from 1996, transsexuals were legally allowed to marry here.)

Gerda Wegener continued loving her husband even after Einar's transformation to Lili Elbe.

Gerda Wegener continued loving her husband even after Einar’s transformation to Lili Elbe. Credit: Universal Pictures

Mama Chan’s July 1971 operation paved the way for sex change surgeries in Singapore and in the region. Singapore’s first sex change operation on a woman took place three years later, between August 1974 to October 1977. As you can imagine, female-to-male conversions are a more complex process and involve several surgical stages. In the 1970s and 1980s, hospitals in Singapore accepted hundreds of sex change patients from other Southeast Asian countries, with foreigners making up around half of all surgeries performed.

However, such operations in public hospitals here have ceased since last year, forcing transgender people wanting sex-reassignment to look to Thailand and South Korea. According to an article published in The Straits Times on Dec 28, 2014, the last known public hospital to perform the surgery is believed to be the National University Hospital, and the last known private medical practitioner still offering the surgery was plastic surgeon Dr Colin Song, who has since left the country.

NUH didn’t provide a reason as to why it has stopped providing such operations. Today, most transsexuals prefer to travel to Thailand or Korea for these medical services, where it is done at a lower cost than it would be if it had been performed here.

To find out about Lili Elbe’s gender reassignment journey, catch The Danish Girl before it ends its run at cinemas here.

Sources: Infopedia, AsiaOne, The Telegraph