Gamal was referring to the new security crackdown that occurred in Egypt last year after a group of people raised rainbow flags at a concert of Lebanese band Mashrou’ Leila in Cairo on Sept. 22, which led to the arrest of 57 LGBT members in just 10 days. They were accused of “debauchery,” “inciting sexual deviancy” and “joining an outlawed group,” despite the fact that transgenderism is regulated in Egypt.

Gamal is just one of the many transgender Egyptians who have run into society’s conservative wall, where gender identities escaping the binary system of men and women are not understood nor tolerated. “First of all, there is a lack of knowledge. Also, people will not treat you as a normal person, and they do not know anything about the surgery,” Gamal told Al-Monitor. “The pressure of the community saying that you are weird is a bit tough,” he added, and “as happened with Mashrou’ Leila, if anyone tries to speak out for our rights, [the authorities] will catch them and send them to jail.”

In his last week of university, six years ago, Gamal’s father died, and with him, Gamal’s only confidant and financial support. He decided to deny his identity and go back to his earlier life to avoid economically and culturally harming his mother and sister, who knew nothing about his situation.

When he moved back to his native Egypt, Gamal decided to talk with his father, the closest person he had, to explain to him how he was feeling. It was then, in the clinic of a renowned physician from Cairo, that both of them heard for the first time what was happening: Gamal was transgender. His gender identity did not match with his assigned sex at birth. They decided to keep it a secret and wait until he finished his studies in order to leave the country and perform gender reassignment surgery abroad.

During the years he spent as a teenager in Saudi Arabia, where his father worked, Ahmed Gamal (a pseudonym used to protect his identity) recalls investing many hours studying the Holy Quran, the Fiqh (Islamic jurisprudence) and the Sunna (practices, customs and traditions of Prophet Muhammad). He was looking for answers — to see if God had only created men and women or if there was something else that escaped this duality and could explain why, since he was a kid, he systematically refused the clothing, the hairstyle and the games that girls around him devotedly reproduced. He was a male trapped in a female’s body.

In 2013, the Egyptian Medical Syndicate released a new Code of Ethics that was a major turning point for the transgender community in the country, since it recognized gender identity disorder (GID) as a medical issue and allowed gender reassignment surgery.

According to the code, gender correction operations are subject to the unanimous approval of the competent committee at the medical syndicate, where patients can only apply if a psychiatrist diagnoses them with GID after “spending not less than two years of psychiatric and hormonal treatment.”

Gaining approval from the syndicate is not an easy task, mainly because one of the committee’s members is a representative from Al-Azhar. “[Al-Azhar] puts a lot of obstacles in the process. They either postpone cases to grant the permission for many years, or they do not give them at all,” Hashem Bahary, a professor of psychiatry who has been working with transgender people for 25 years, told Al-Monitor. “It makes no sense for an Islamic [institution] to be in the committee. It is a surgical condition.”

According to Bahary, only 5-10 cases were approved by the committee in 2017 due to an Al-Azhar blockade, while this year already 20-30 cases have been approved as a consequence of a slight lifting of the suspensions from Al-Azhar’s representative. When requests are not approved, performing the surgery abroad or underground in Egypt are the only alternatives.

Once people have passed through this severe, lengthy and expensive process, economic, social and bureaucratic problems not only persist but may even increase, especially for transgender women. “Those who are transitioning to be a woman are way more attacked by society because they are treated as gay men and seen as people out of their mind since they quit all their privileges as men and chose voluntarily to be women,” Dalia Abdel Hameed, a gender rights officer in the Egyptian Initiative for Personal Rights, told Al-Monitor.

However, Abdel Hameed highlighted some of the results achieved by the transgender community. She said, “They are partially organized, so they have made some progress. For example, some fatwas allow them to go after the medical treatment, to the surgery assignments.”

According to Abdel Hameed, many transgender groups operate in secrecy. “We have a community creating jobs to help those who are fired after the surgery. Some have their own businesses and bring others to work [with them],” Gamal said.

“The current generation is very courageous, and they try to organize themselves [despite the fact that] it is very difficult because the general opinion is not supportive of the LGBT community,” she noted. “The positive attitude is higher among the younger generation and [especially] the politicized groups, people engaged in social movements and those who were part of the revolution” and have a more liberal stand, she added.

Bahary, who is currently managing around 70 cases, also noticed a change of patterns, saying, “The community is starting to accept that there are cases of transsexuality. Even some families that do not accept the idea start hearing about it, and the younger generations start pressuring them.”

But Gamal, who is about to start his sex reassignment surgery in Egypt, assures that he will only explain his situation to his family once he has completed the process. For him, the legal tolerance of the state and the support from certain liberal groups is far from being enough.