of the parties concerned.227 There have also been cases in which patients could not
obtain the consent of family members and so were rejected for SRS; in their despair
they mutilated themselves by cutting off their own male sex organs in order to achieve
their goal.228
In China, SRS is also a relatively expensive procedure and is not included under
medical insurance plans. Given the amount of trouble involved in undergoing SRS in
China, many people choose to travel to Thailand and have it done there.
Gender alteration in documents
States have legitimate reasons for registering people’s sex at birth, and for regulating
the manner in which people can change their gender marker on documents later in life.
Sex is one characteristic used to identify people and government bodies may need to
have access to this information to carry out their duties. In some contexts the State has
specific, positive obligations to protect people from r