As a transgender man living in Egypt, my ultimate goal was to change the gender marker on my official documents (my national ID and passport) so they would reflect my true identity. I found out, however, that there is no official route to establish this. Therefore, I went to the only available option, which is to undergo a psychological evaluation to receive a medical report diagnosing me with gender dysphoria, a condition recognized by medical authorities as a mismatch between one’s assigned gender at birth and one’s gender identity. Normally, in different countries, the two routes are not separate but intertwined, as the psychological evaluation is the first step, with gender affirming surgeries and gender marker changes following it. 

The only place where I could access such evaluations was the gender clinic at Al-Qasr Al-Aini, a public hospital in Cairo. This clinic operates under the hospital’s psychology department and is meant to offer monthly assessments to transgender individuals. From December 2023 to May 2025, I attended the clinic once per month, completing 12 sessions in total, hoping that the resulting report would help me access gender-affirming surgeries and eventually change my legal documents.

I first learned about the clinic through a friend. There was no information anywhere regarding the clinic, but I only found mentions of other clinics in Cairo at Al-Hussein and El-Demerdash. However, I learned later on that they had already shut down, the reasons behind their shutdown were undocumented and vague, and the only piece of news I could find referenced the burning of the Al-Hussein building in 2018. Still, I was never certain if that incident was truly responsible for the clinic’s closure, especially since other clinics in the same building resumed operation after its restoration. I also did not know of any clinics operating in the same manner outside of Cairo, so Al-Qasr Al-Aini remained the only option available to me.

Each visit to the clinic required enormous mental and physical effort. The sessions were held on the first Sunday of every month, and to secure a spot, I had to wake up as early as 5 a.m., sometimes earlier, which was physically exhausting, especially if I had work or lectures the night before it. Only 35 people were allowed per month, yet more than 50 would show up, desperate to be seen. This placed a huge mental pressure, as being late by even a few minutes could mean losing your place and waiting another month, which would extend the chance to get the diagnostic medical report by an additional month. 

The atmosphere was chaotic: patients rushed between rooms to register, retrieve their files, and complete the evaluation, all under pressure and uncertainty. Once I managed to finish the process for the day, it felt like a temporary relief before the cycle of bureaucratic frustration began again the next month. 

This overcrowding stemmed from the severe shortage of specialized staff (as the clinic operated with only two or three doctors, including the head psychiatrist, most of which were general psychologists with no specialized training in gender dysphoria) and the fact that this clinic was the only option for transgender people after the shutdown of all other similar clinics in Egypt. 

At the beginning of 2024, when I first started attending the sessions, waking up early was still manageable. I usually arrived around 8 or 9 a.m., which was considered early enough at the time. However, by late 2024 and early 2025, the situation had changed significantly. As the clinic began to attract more attention among the trans community in different social media outlets and therefore became more crowded, arriving at 8 a.m. was no longer sufficient. Some people even spent the night at the hospital just to secure a spot, making 6 a.m., or even earlier, the new norm for arrival. Something for which trans people themselves are not to blame, but rather the organization of the hospital and the clinic. 

As it got more crowded, some people began volunteering to buy the ticket for the session on behalf of others (that were obtained each session to book the session before entering to secure a spot), to help ease the burden of having to wait in a queue and paying 10 EGP (around 0.2$) for the ticket, fill out all the information, wait again till the issuance of the ticket and then wait to be called to enter the clinic. This was a kind gesture that showed solidarity in what appeared to be a strong community of people sharing a common suffering, but at the same time showed the chaotic nature of the clinic and lack of organization.

Additionally, this crowding led to a change in the behaviour of the staff (the doctor and the organizing staff that would call our names to enter); some were screaming at us, and some even locked us in a waiting area outside of the clinic where all the doors were shut down with no way out until it was time for our sessions. this action was the most humiliating, as it felt like a prison or a zoo, especially with this area having a door with iron bars where people outside it, booking their sessions, could see us, and where I’ve witnessed a lot of people among us being laughed at or made fun of by outsiders.

Other cis (non-trans) patients knew of our existence, and where we’re located while waiting, this has sometimes led to arguments emerging between trans people and other patients, where trans people mostly get the blame for it, and are threatened with shutting down the clinic. therefore, needless to say, it wasn’t a safe space or a space to ease the tensions we go through, but rather a space that adds to these tensions.

When I first came to the clinic, I expected something different, which was that I would get enough time to speak about my concerns and get answers for what would be upcoming in my journey. The first session was with a general psychiatrist, in a separate general physiatry room (نفسي عام), who was very friendly and welcoming and gave me time to speak. However, upon entering the gender clinic itself, I found that sessions were in groups of 3–4, and each session took no longer than 5 minutes, with generalized questions such as “How are you? How is work/school? Are you still on hormones? Are you taking any medications?” and ended with a “thank you, goodbye.”

It was a checklist to evaluate progress, to test if I’m still trans, which was probably measured by my ability to bear all of this, I truly expected to spend time talking about my life and my fears; however, when I tried to do that by telling the doctor I’m stressed about the future, I was met with “we’re in the present. see you next session.” I walked out speechless and frustrated, and since then, I didn’t even try to speak so I wouldn’t face any of these cold comments; instead, I remained silent and answered briefly with “I’m okay… school is okay… I’m still on hormones… I’m not taking any medications.” while pausing to give her time to fill the checklist and send me out on my way so I could finally breathe and go about my day (or what is left of it).

The expectation I had before facing the truth stemmed from the first session in the general physiatry clinic where I had slightly more time to speak, and private sessions I attended at a private psychological clinic, where I had more than an hour to speak comfortably and freely, but gave up the private sessions due to financial constraints – I had two sessions per month each costing 900 EGP (around 18$)- and a delay on behalf of the doctor in giving any reports or even hinting at it, which I later on learnt from peers who shared the same experience that it was due to a fear common among doctors in private psychiatry clinics of bearing the responsibility that comes with issuing such reports. This responsibility could range from minor issues, such as problems with the individual’s family, to more serious consequences, like being accused of not following certain protocols (that I personally have no access to or knowledge of).

Additionally, I expected to receive tests and real evaluations that would prove I have gender dysphoria such as GIDYQ-AA or Utrecht Gender Dysphoria Scale (which both include questions regarding discomfort with assigned sex, desire to be perceived as another gender and the extent to which one identifies with preferred gender roles) that I viewed hearing the stories of transgender people outside of Egypt, and the results of such tests and evaluations to be written in the final report in details, so I would have documented proof in hand that would allow me to get my gender affirming surgeries and change my legal documents, but rather I only got an MMPI test (a psychological assessment tool for diagnosing mental health disorders), an IQ test (for intelligence), and a test for gender dysphoria that while effective in theory; as it was close to the tests previously mentioned, was later on thrown in the trash as the sessions remained the same and none of the test results were written in the report with all of the reports being in the same standard formatting, therefore, this test could be merely a bureaucratic procedure. 

Regardless of all this, two reasons kept me going: the first was to meet my friends and spend time together, as well as getting to know people who shared the same experience. This, in itself, was therapeutic, as we talked to each other and shared our sorrows and the difficulties we faced. And the second was getting the medical report. I knew after a few encounters with people inside the clinic from the beginning that the medical report had no effectiveness in achieving anything in terms of changing the gender marker in my legal identification or helping me get my gender-affirming surgeries as the report had no formal recommendation for the surgeries which was required to obtain them and it had a disclaimer at the end stating that “This report has been issued at the patient’s request, and neither the doctor nor the hospital holds any responsibility.”, but I was trying to fight back, even if all I had was a wooden stick, by taking any chance I could take just to feel like I was achieving something rather than whining about my life.

The formatting of the report isn’t the only factor contributing to its uselessness; external variables also play a role. Gender-affirming surgeries have been banned in Egypt as of 2023, and surgeons who perform them are subject to punishment (Noralla, 2024). Therefore, even if Al-Qasr Al-Aini report recommended such procedures, surgeons would still refuse to conduct them for fear of losing their medical licenses or facing other penalties. In terms of changing the gender marker in legal documents, this too would remain inaccessible, even with a favorable recommendation in Al-Qasr Al-Aini medical report. As of 2024, Egypt has restricted legal gender recognition to intersex individuals only, under Directive No. 25/2024, which requires a DNA test to prove that the individual seeking legal recognition is Intersex, not transgender (Noralla, 2024).

In conclusion, my time at the Al-Qasr Al-Aini gender clinic was more than a routine medical process; it was a lived encounter with how the state regulates trans lives through delay, exhaustion, and ambiguity. And I can truly observe how the system never takes trans people into account or cares about their wellbeing, and that the clinic is maybe a tool to silence trans people for a year, or what is more convincing is it being a façade of protecting human rights by allegedly having “a clinic for transgender people”. Yet within that frustration, I also saw moments of solidarity and care among strangers, which reminders that in the absence of formal support, community becomes a vital form of survival.