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Further, non-recognition of identity of Hijras /transgender persons results in them facing extreme discrimination in all spheres of society, especially in the field of employment, education, healthcare etc.Hijras/transgender persons face huge discrimination in access to public spaces like restaurants, cinemas, shops, malls etc.In some jurisdictions, transgender people (who are considered non-transsexual) can benefit from the legal recognition given to transsexual people.In some countries, an explicit medical diagnosis of "transsexualism" is (at least formally) necessary.Many transsexual people have permanent surgery to change their body, sexual reassignment surgery (SRS) or semi-permanently change their body by hormonal means, hormone replacement therapy (HRT).In many countries, some of these modifications are required for legal recognition.0.8% (1.125) of 18- to 24-year-old university students who are birth-assigned males (whose sex/gender as indicated on their ID card is male) report that the ‘sex/gender I feel in my heart’ is female, while another 0.4% indicating that their perceived gender was ‘other’.

Once the birth record is altered they can be issued with a new birth certificate and identity document, and are considered "for all purposes" to be of the new sex.

Justice KS Radhakrishnan noted in his decision that, "Seldom, our society realizes or cares to realize the trauma, agony and pain which the members of Transgender community undergo, nor appreciates the innate feelings of the members of the Transgender community, especially of those whose mind and body disown their biological sex", adding: Non-recognition of the identity of Hijras/transgender persons denies them equal protection of law, thereby leaving them extremely vulnerable to harassment, violence and sexual assault in public spaces, at home and in jail, also by the police.

Sexual assault, including molestation, rape, forced anal and oral sex, gang rape and stripping is being committed with impunity and there are reliable statistics and materials to support such activities.

In others, a diagnosis of "gender dysphoria", or simply the fact that one has established a non-conforming gender role, can be sufficient for some or all of the legal recognition available.

The DSM-V recognizes gender dysphoria as an official diagnosis.

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