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Introduction: Mak nyahs are locally known male-to-female transgenders in Malaysia. In Western countries, medicalization of transgenderism allows strictly selected patients to undergo sex reassignment surgery. However, a standardized treatment system is not yet available in Malaysia. A number of mak nyahs underwent sex reassignment surgery at their own will. This study aimed to explore mak nyahs' knowledge and perception on sex reassignment surgery. Materials and Methods: A qualitative research was carried out from 13th July 2016 till 31st August 2016 among 8 adult mak nyahs in Kuantan, Pahang. Snowball sampling was used. Participants who gave verbal consent were interviewed individually and in focus groups. Data obtained was transcribed and used as the primary data source. Results: All informants were Malays and Muslims. They generally had some knowledge about the standard procedures and risks in sex reassignment surgery. All informants expressed their desire to have the surgery, but chose not to. Reasons discouraging them from having the surgery were: i) religion, ii) forbiddance from family, iii) fear of regret, iv) death from surgery, and v) the lack of necessity. Factors driving them to have the surgery: i) more income from sex work, ii) pressure from sex clients, iii) securing a stable relationship, iv) self-satisfaction, and v) hope for a better future. Conclusion: Religion seemed to be the main reason refraining them from undertaking the surgery. Counselling mak nyahs should include the advantages and disadvantages of sexual reassignment surgery. Islamic religious preaching is very important to help reduce high risk behaviours, as well as teaching mak nyahs to cope with challenges in adult life. Further research is necessary to show association between religious knowledge and successful rehabilitation of the mak nyahs' community. [ABSTRACT FROM AUTHOR]

Introduction: Transsexuals face discriminations and rejections from the Malaysian society. The number of studies done on understanding the phenomenology, experiences, and problems faced by transsexuals is still few in Malaysia. This research aims to document their psycho-social and spiritual backgrounds and the relevant experiences, and to explore their perceptions and needs as male-to-female transsexuals in the context of Persatuan Insaf Pahang, Malaysia. Materials and Methods: A qualitative research was carried out in July and August 2015 among eight male-to-female transsexual adults in Kuantan, Pahang. Snowball sampling was used. Participants who gave consent were interviewed in two focus groups. Data obtained was transcribed and used as the primary data source. Results: Subjects in this study reported confusions over their gender identity since childhood. They struggled against conflicts regarding their transsexuality in adolescence, and eventually many quit their studies. As adults, they were discriminated against in employment and religious settings. They provided positive feedbacks on religious authorities who could understand problems unique to transsexuals and empathise with the transsexual community. Conclusion: The psycho-sexual phenomenology is the same in transsexuals all over the world. Misunderstanding and discrimination from the society remain heavy towards this community. Transsexuals should learn to adapt to meeting expectations from the society as well, so they could be accepted in public. They will need religious guidance and spiritual support for better quality of life. Dedicated efforts are still needed in training professionals in the educational, medical, and religious fields to attend to the specific needs of transsexuals in this country. [ABSTRACT FROM AUTHOR]