Sexual Reassignment Therapy form the Viewpoint of Shia Scholars

In Islamic jurisprudence there are two terms used for hermaphrodites. One term refers to a hermaphrodite whose gender cannot be determined, meaning his biological sex is just as male as it is female. In this case, surgery can be performed and the parents of the child choose the sex of the patient. The second term refers to one who is not completely biologically one sex, but the majority of his biological features fare with either being male or female. In this case, if surgery is needed it is performed to complete the sex that is dominant.

The issue of sexual reassignment therapy, or sex change, is a heated issue within Islamic jurisprudence. A number of Sunni Muslims strongly ridicule some of the prominent Shia scholars who have issued verdicts apparently allowing sex change. This article will try and explain the issue of sex change, the hermaphrodite dilemma, and the verdicts proposed by Shia jurists.

There are people who claim that they are born with the physical characteristics of one sex while being the opposite gender. Gender is related to several key concepts, such as gender identity, which is the subjective state in which someone comes to say, “I am a man,” or “I am a woman.” These people are called transexuals, they feel that they are one sex, though biologically they are the other.

There are two steps to the procedure of sex change. First, Hormone replacement therapy (modifies secondary sex characteristics) and second, sex reassignment surgery (alters primary sex characteristics).

It is estimated that in the United States about 1 in 30,000 men and 1 in 100,000 females decide that they want to change their sex. These numbers are disputed and there are not any official numbers which can be referred to. But, religion has been opposed to it. For instance, the Roman Catholic church states that changing sex is not possible. They state a person’s sex is not changed in eyes of church even after surgeries. Hence, the sex change operation is mutilation and therefore immoral.

There is another class of people who have this procedure, the hermaphrodites. The term hermaphrodite stems from the Greek hermaphroditos which is derived from the Greek god Hermaphroditos who is said to be the offspring of Hermes and Aphrodite and possessed by male and female sexual organs. In the contemporary era, the term intersex is also used to refer to one who has been born with both organs. The World Health Organization (WHO) defines this term as a congenital anomaly of the reproductive and sexual system.

The Australian government defines it as being the status of having physical, hormonal, or genetic features that are: (a) neither wholly female nor wholly male; or (b) a combination of female and male; or (c) neither female or male. The Australian guidelines on the recognition of sex and gender states that people who are intersex may identify their gender as male, female, or X.

Biological sex is determined by five characteristics which are seen at birth. When one has all of these five characteristics in common with one sex they are considered to be that sex. If not, they are classified as intersex. These five characteristics are: the number and type of sex chromosomes, the type of gonads, the sex hormones, the internal reproductive anatomy, and the external genitialia.

There are two main types of hermaphroditism: true hermaphroditism and pseudohermaphroditism. True hermaphroditism is a term which refers to an individual who is born with both ovarian and testicular tissue. Pseudohermaphroditism refers to an individual who is born with a secondary sexual characteristic or a phenotype that is different from that would be expected on the basis of the gonadal tissue.

In Islamic jurisprudence there are two terms used for hermaphrodites. One term refers to a hermaphrodite whose gender cannot be determined, meaning his biological sex is just as male as it is female. In this case, surgery can be performed and the parents of the child choose the sex of the patient. The second term refers to one who is not completely biologically one sex, but the majority of his biological features fare with either being male or female. In this case, if surgery is needed it is performed to complete the sex that is dominant.

The method of determining the sex of a hermaphrodite, as mentioned by the Shia jurists supported by traditions, is that whatever organ the person urinates from is the organ which determines its sex. Hence, if a hermaphrodite urinates from the male sexual organ than he is considered a man and can marry a woman.

The possible Islamic jurisprudential problems with sexual reassignment therapy would be two things: what happens after the change of sex and the unnecessary exposure of one’s private parts to the person performing the surgery. Both of these points should be addressed in the verdicts of the scholars.

In the book Islamic Rulings; Medical Issues, Ayatollah Khamenei was asked the following questions:

Question 63: What ruling does changing sex from a man to a woman or a woman to a man by surgery have? Answer: This surgery, in itself, has no problem, but one must stay away from forbidden actions that can happen while doing this.

Question 64: What ruling does one’s previous marriage have if a man and woman get married and then change their sex? If the marriage becomes invalid does the man have to pay the complete dowry to the woman? Answer: The marriage would become void. If the couple had intercourse then the whole dowry must be paid and the ruling of paying half of the dowry before intercourse is not certain.

Question 65: What ruling does a marriage have if the husband and wife change sex at the same time? Answer: It would not be far-fetched that their marriage would remain valid, but as a precaution they should renew their marriage contract.

Ayatollah Khamenei briefly addressed the two problems mentioned above in his answers. He gave the general permission to the surgery, but also used the phrase “in and of itself” which means that there can be no sin in the procedure. Exposing one’s private parts is a sin and therefore must be refrained from But, that being said, if there is a way, or in the future if one develops a method without having to expose one’s private parts there would be no problem.

Regarding the second point, it is understood that the person would change sex in the eyes of Islam if he had this surgery. Therefore, a man who changed into a woman would have the rulings of a woman. This is contrary to the Catholic Church’s position mentioned earlier.

On the Arabic section of Ayatollah Sistani’s website there one question regarding the permissibility of changing sex. Ayatollah Sistani answers by stating that there are two types of surgeries regarding sex change. The first surgery is what occurs in the contemporary world, where a man changes his genitals into female genitals and takes female hormone medication or a woman changes her genitals into male genitals and takes male hormone medication. This type of surgery DOES NOT result in one’s sex being changed according to Ayatollah Sistani. That means the surgery is useless and one exposes his/her private parts thus rendering it haram. The second form of surgery described as changing one’s external genitals and internal sexual organs along with hormone medication. This would mean, for instance, that a man who changes into a female would be able to bear children. Medicine has not evolved to the point where this is possible in the contemporary world. But, Ayatollah Sistani states that if this takes place in the future one’s sex would change and he/she would become the opposite gender.

Ayatollah Sistani also addresses both potential problems in these answers. First, he gives permission when both internal organs and external genitals are changed, but prohibits the change of only external genitals per exposure of private parts. Thus, clearly leaving room for future enhancements of the surgery. Ayatollah Sistani also clearly states that after the surgery one would have the rulings of the new gender.

Therefore, the Islamic position is that in and of itself there is no problem with changing one’s sex (although these two maraja’ have different views of what changing sex is). But, in doing so, the person must refrain from all prohibited acts. If one sins and exposes his or her private parts for the procedure and then successfully changes sex, then the rulings of the new gender will apply to him. The sin of exposing one’s private parts may be mitigated if it can be proven that it was done out of necessity. And Allah knows best.

The article was written by Sheikh Hamid Waqar and first published on 14publications.