When Adele Britz went to school at five, other children were so fascinated by her femininity, they referred to her as "dogtertjie" (little girl).
Born a male in a conservative Afrikaans family in Pretoria, he was named Adam and fully expected to play "boy" sports such as cricket and rugby - even though he couldn't identify with such sporting activities.
“I was therefore quite offended by the dogtertjie reference because I was supposed to be ‘male’ and in my little world I expected to be called a boy. But deep down I also knew that I was not a boy I just didn't know how to describe myself at the time.
Coming from a family of five boys, my family always reaffirmed to me that I was a boy, but I knew this was not the real me. I could identify more with being a girl than a boy,” she recalled.
Now 52, Britz, who lives in Strand, can finally call herself a "real woman" without any fear of contradiction following gender-affirming surgery - loosely known as a sex change operation.
The surgery, which she had at Groote Schuur at the end of August, follows seven years of transition into the woman she is today.
Groote Schuur is one of two state hospitals in the country that performs gender-affirming surgery. The other hospital is Steve Biko Academic Hospital in Pretoria.
Even though Britz didn’t necessarily have to go for surgery, as she could still be recognised as a "legal woman" even without sex reassignment (South African law permits alteration of sex description and sex status), she says having the surgery has made her feel "complete and relieved" and reflects her authentic self.
“Since I was a child I knew that I was a woman trapped in a man's body. Even though I lived most of my life as a gay man, but I knew that's not who I was. I lived that life because I was trying to fit into society I was trying to be someone I was not,” she said.
Adele Britz before the surgery. Picture: Supplied
Following years of identity crisis that resulted in serious depression and suicidal thoughts, Britz says the surgery not only changed her body physically, but it has already improved her mental state.
“I feel stronger mentally and much more confident. I don’t have to battle with my feelings and hide I’m finally me and it feels good.
"Even though coming out as transgender woman was difficult and has resulted in rejection and my family disowning me, it’s the best decision that I’ve made for myself,” she says.
Gender-affirming surgery has been in the news more recently after Caitlyn Jenner had such surgery early this year.
In her memoir, The Secrets of My Life, which came out in April, the 67-year-old former Olympian said she felt "wonderful and liberated" after she had the sex reassignment surgery in January.
Born Bruce Jenner, she publicly announced her transition from male to female about two years ago.
Britz, who came out of her closet about her gender at 45, when she started counselling sessions at Groote Schuur Transgender Unit, also recognises that she is extremely lucky to have her gender-affirming surgery within seven years of transitioning into transgender woman. For others, the waiting period for surgery can take more than 20 years.
The gender clinic, which is tailored to the needs of transgender patients, can only perform four gender affirming surgeries a year as the Western Cape Department of Health allocates four days of the year for gender surgeries. Surgeons can operate for up to eight to 12 hours on each of those days. The hospital covers gender surgeries, including breast and pelvic procedures, according to a sliding scale of income.
Dr Kevin Adams, a plastic surgeon who performed the surgery on Britz, said resources are so overwhelmed by demand that the waiting period for gender surgery in the Western Cape is about 25 years. As private procedures cost between R200 000 and R300 000, many transgender patients have no choice but to wait.
Adams said surgeons perform the surgery by reconstructing the original genitals of recipients.
The gender clinic - which provides plastic surgeons, psychiatrists, endocrinologists, social workers and gender activists who work together to provide transgender services in the Western Cape - is often referred to as the best unit of its kind in the country.
In the past three years, Adams said the hospital has performed 13 gender surgeries, and this year it has already performed five such operations, mainly men transitioning into transgender women.
The ratio of trans women to trans men is 2 to 1 men transitioning to women is twice as common.
Asked how the unit decides who receives surgery first, Adams said: “All patients have equal priority unless their treatment is life-threatening. It would be unreasonable to take away the opportunity to have breast reconstruction from a woman who survived breast cancer, or a person who has a disfigured face after a car accident. Recipients are prioritised strictly on time of presentation. ”
Ronald Addinall-Van Straaten, a UCT lecturer, clinical social worker and sexologist specialising in gender identity, who also volunteers at an LGBTI organisation the Triangle Project, said while gender-affirming surgery “radically improved the quality of lives” of transgender people and improved their mental state, transgender health sadly still didn’t get the priority it deserved.
He said while the public sector was short of resources and could only perform a handful of gender surgeries each year, in the private sector many medical aids were still reluctant to fund such surgeries.
Meanwhile, Britz says she is looking forward to her new life.
“I’ve never felt so fulfilled. Yes, I miss my family that disowned me because of my transition, but I don’t miss the nights I spent alone battling with my feelings wondering whether I’m a girl or boy. I see this sex reassignment surgery as a second chance that God has given me to be real me...a woman."