Fiqh of Medicine
“When is it permissible to do a sex-change operation from
male to female or vice versa?”
Question:
What is the ruling on sex change operations
(gender reassignment surgery) in the case of necessity? For example, if a child
is born and has genitalia that does not match his gender, and it is possible to
surgically reconstruct it? What is the ruling if this child grows up and
becomes transgendered, and thus cannot get married, and this is on the basis of
medical evidence on which the doctors are agreed, but social standards reject
this surgery, and this sex-change operation is for the sake of medical
treatment?
Answer:
Praise be to Allah.
Firstly:
It is not possible for anyone, no matter who he is, to change
the creation of Allah, may He be exalted, from male to female or vice versa.
Whoever Allah, may He be exalted, has created as a male can never become a
female who menstruates and gives birth!
Yes, the doctors may tamper with him to satisfy his perversion
so that he will think that he has become a woman, but he will never be truly
female and will live in a state of anxiety and worry, which may lead him to
commit suicide.
Secondly:
What a person may feel in his mind and heart, that he is of a
gender other than what he appears to be to us not give him an excuse to change
his gender; rather it comes under the heading of following the Shaytaan in
changing the creation of Allah – outwardly but not truly – and those feelings
do not make it permissible for him to undergo surgery or take medicines and
hormones to change his outward appearance. Rather he must be content with the
decree of Allah, may He be exalted, and treat his case on the basis of faith
and obedience to Allah. It is not permissible for him to make himself appear
outwardly to be of a gender other than his real gender with which Allah created
him, otherwise he will be committing a major sin; if this person is really
female then she will be masculinised and if he is really male then he will be
effeminate.
The surgery that is permissible in such cases is if a person was
originally created male or female, but his genital organs are hidden. In that
case it is permissible to do surgery in order to make those organs appear, and
to give him or her medicine or hormones to strengthen the characteristics with
which Allah originally created him or her.
But in the case of one who was created with both female and male
genitalia – this is what is called ambiguous intersex – it is not permissible
to be hasty in removing one and making the other more apparent. Rather we
should wait until it is known what Allah, may He be exalted, will decree for
this individual, which may become apparent after some time has passed.
There follows a detailed fatwa from the scholars of the Standing
Committee for Issuing Fatwas, who were asked about a case similar to what is
mentioned in the question. They replied:
Firstly: Allah, may He be exalted, says (interpretation of the
meaning):
“To Allah belongs the kingdom of the heavens
and the earth. He creates what He wills. He bestows female (offspring) upon
whom He wills, and bestows male (offspring) upon whom He wills. Or He bestows
both males and females, and He renders barren whom He wills. Verily, He is the
All-Knower and is Able to do all things” [ash-Shoora 42:49].
So the Muslim
must accept and be content with whatever Allah creates and decrees.
In your case, if you are as you mentioned, that you are certain
of your masculinity and that you can play the male role efficiently, even if
you have not actually engaged in any sexual activity with any person, then you
must preserve your masculinity and accept that which Allah has granted to you
of virtue and a favourable situation, and you must praise Him for having
created you as a man, for men are better than women and of a higher status, and
are more able to serve Islam and humanity than women, as is indicated by the
words of Allah, may He be exalted (interpretation of the meaning):
“Men are the
protectors and maintainers of women, because Allah has made one of them to
excel the other, and because they spend (to support them) from their means”
[an-Nisa’ 4:34].
What Allah, may He be exalted, has told us about the story of
the wife of ‘Imraan, when she dedicated what was in her womb to Allah, to be
devoted to service of His religion and to take care of the affairs of the House
of Allah, and other texts, and the testimony of real life in countries in which
common sense has not been distorted, offers universal, practical evidence, in
addition to the evidence that is mentioned in the Book of Allah and the Sunnah
of His Prophet (blessings and peace of Allah be upon him), which highlights the
superiority of men over women.
Secondly: once your masculinity is proven and established, then
having surgery to turn into a female – as you think – is changing the creation
of Allah, and is an expression of discontent on your part with what Allah has
chosen for you, even if we assume that the surgery is going to be successful
and lead to what you want of becoming female. But there is no way that it can
be successful, for both males and females have their own, distinct faculties
and physical makeup, the development and characteristics of which are decreed
only by Allah, may He be exalted, and are not just the penis of the male or the
vaginal opening of the female. Rather the man has a complete, integrated system
comprising the testicles and other organs, each of which has a special function
and characteristics, and produces specific secretions and so on. Likewise the
woman has a uterus and other connected parts that work in harmony with it, and
each part has its own function and characteristics, and produces specific
secretions and so on. Among of all them there are connections and harmony over
which none of His creation have any power of estimation, creation, control, management
or preservation. Rather all of that is under the control of Allah, the
All-Knowing, Most Wise, Most High, Almighty, Most Kind and All-Aware.
Therefore the surgery that you want to do is a kind of tampering
and striving for something in which there is no benefit. In fact it may be
dangerous; if it does not lead to death, then at the very least it will lead to
taking away that which Allah has given you without you attaining what you want,
and you will still be affected by what you have mentioned of psychological
problems that you want to get rid of by means of this surgery that is bound to
fail.
Thirdly: if your masculinity is not established, and you only
think that you are a man because of what you see in your body of outward
masculine appearance, in contrast to what you feel in yourself of having
feminine characteristics and an inclination towards males and being sexually
attracted to them, then you should examine your situation and not go ahead with
the surgery that you have mentioned. You should consult experienced specialist
doctors. If they determine that you are male in outward appearance but are in
fact female, then you may submit yourself to their treatment, so that they can
bring out your femininity by doing surgery. But that will not in fact be a sex
change from male to female, because this will not be up to them; rather it will
be bringing out your true nature and removing what is in your body, and what
you feel deep inside you of confusion and ambiguity.
But if nothing is clear to
the experts, then do not take the risk of undergoing this surgery; be content
with the decree of Allah and be patient with what has befallen you, seeking to
please your Lord and protecting yourself against the possible consequences of
doing an operation without guidance and insight concerning your condition. Turn
to Allah and beseech Him to relieve you of what you are facing, and to heal you
from your psychological problems, for control of all things is in His hand, may
He be glorified, and He is able to do all things. End quote.
Shaykh ‘Abd al-‘Azeez ibn Baaz, Shaykh ‘Abd ar-Razzaaq ‘Afeefi,
Shaykh ‘Abdullah ibn Qa‘ood, Shaykh ‘Abdullah ibn Ghadyaan
Fataawa al-Lajnah ad-Daa’imah (25/45-49)
And Allah knows best.
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