Balancing benefits and harm: Chemical use and bodily transformation among Indonesia's transgender waria

Abstract

Background
Members of Indonesia's diverse male-to-female transgender community often describe themselves as waria. Waria do not equate being feminine with being female. They do not want to be women; they aspire to be like women. It entails cultivating mannerisms and wearing make-up and women's clothes, shaving one's legs and styling one's hair. But some go further in their practices of self-administered, chemically-assisted bodily transformation.

Methods
Field research took place in Makassar, the capital city of South Sulawesi; in a smaller town in the regency of Bulukumba on the south coast of Sulawesi; and in the city of Yogyakarta in Central Java. Data were collected through repeated in-depth interviews with ten waria youths aged between 18 and 26 in each site; interviews with pharmacists, drug and cosmetics store clerks; three focus group discussions at each site; and participant observation.

Results
Our respondents saw their bodies as ‘projects’ they can manipulate with pharmaceutical products and cosmetics. To lighten their skin, they experimented with different brands of exfoliating liquid, whitening cream, powder, foundation, face soap and skin scrub. To grow breasts and reduce muscle mass, they experimented with different brands and dosages of contraceptive pills and injections in order to get faster, better and longer-lasting results.

Conclusion
Harm reduction programs often neglect chemicals that are not narcotics, not related to sexually transmitted infections, and which are legally and freely available. Safety issues arise when otherwise safe products are used off-label in large quantities. Drug policy-makers are paying insufficient attention to the safety of cosmetics.

Full text

International
Journal
of
Drug
Policy
25
(2014)
789–797
Contents
lists
available
at
ScienceDirect
International
Journal
of
Drug
Policy
j
ourna
l
h
om
epage:
www.elsevier.com/locate/drugpo
Research
paper
Balancing
benefits
and
harm:
Chemical
use
and
bodily
transformation
among
Indonesia’s
transgender
waria
Nurul
Ilmi
Idrus
a,b,∗
,
Takeo
David
Hymans
b
a
Department
of
Anthropology,
Faculty
of
Social
and
Political
Sciences,
Hasanuddin
University,
Makassar,
Indonesia
b
European
Research
Council
Chemical
Youth
project,
University
of
Amsterdam,
The
Netherlands
a
r
t
i
c
l
e
i
n
f
o
Article
history:
Received
20
December
2013
Received
in
revised
form
9
June
2014
Accepted
10
June
2014
Keywords:
Waria
Indonesia
Chemical
use
Beauty
enhancement
Harm
reduction
a
b
s
t
r
a
c
t
Background:
Members
of
Indonesia’s
diverse
male-to-female
transgender
community
often
describe
themselves
as
waria.
Waria
do
not
equate
being
feminine
with
being
female.
They
do
not
want
to
be
women;
they
aspire
to
be
like
women.
It
entails
cultivating
mannerisms
and
wearing
make-up
and
women’s
clothes,
shaving
one’s
legs
and
styling
one’s
hair.
But
some
go
further
in
their
practices
of
self-administered,
chemically
assisted
bodily
transformation.
Methods:
Field
research
took
place
in
Makassar,
the
capital
city
of
South
Sulawesi;
in
a
smaller
town
in
the
regency
of
Bulukumba
on
the
south
coast
of
Sulawesi;
and
in
the
special
region
of
Yogyakarta
in
Java.
Data
were
collected
through
repeated
in-depth
interviews
with
ten
waria
youths
aged
between
18
and
26
in
each
site;
interviews
with
pharmacists,
drug
and
cosmetics
store
clerks;
three
focus
group
discussions
at
each
site;
and
participant
observation.
Results:
Our
respondents
saw
their
bodies
as
‘projects’
they
can
manipulate
with
pharmaceutical
prod-
ucts
and
cosmetics.
To
lighten
their
skin,
they
experimented
with
different
brands
of
exfoliating
liquid,
whitening
cream,
powder,
foundation,
face
soap
and
skin
scrub.
To
grow
breasts
and
reduce
muscle
mass,
they
experimented
with
different
brands
and
dosages
of
contraceptive
pills
and
injections
in
order
to
get
faster,
better
and
longer-lasting
results.
Conclusion:
Harm
reduction
programs
often
neglect
chemicals
that
are
not
narcotics,
not
related
to
sexu-
ally
transmitted
infections,
and
which
are
legally
and
freely
available.
Safety
issues
arise
when
otherwise
safe
products
are
used
off-label
in
large
quantities.
Drug
policy-makers
are
paying
insufficient
attention
to
the
safety
of
cosmetics.
©
2014
The
Authors.
Published
by
Elsevier
B.V.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(http://creativecommons.org/licenses/by-nc-nd/3.0/
).
Introduction
Studies
of
transgender
men
and
women
have
often
focused
on
their
gender
identities
and
how
societies
differ
in
their
acceptance
of
gender
ambiguity
(Besnier
&
Alexeyeff,
2013;
Graham-Davies,
2010;
Johnson,
1997;
Koon,
2002;
Nanda,
1990,
2000;
Sinnott,
2004
).
These
studies,
which
often
focus
on
how
transgender
indi-
viduals
‘perform’
gender,
have
generally
portrayed
transgenders
as
stigmatized
and
disempowered
groups
in
heteronormative
societies.
A
number
of
recent
studies
have
addressed
non-
heteronormative
subjectivities
in
Indonesia
(Blackwood,
1998,
∗
Corresponding
author
at:
Department
of
Anthropology,
Faculty
of
Social
and
Political
Sciences,
Kampus
Unhas
Tamalanrea,
KM
10,
Makassar
90245,
Indonesia.
E-mail
addresses:
nurulilmiidrus@yahoo.com
(N.I.
Idrus),
davidhymans@hotmail.com,
nurulilmiidrus@hotmail.com
(T.D.
Hymans).
2005;
Boellstorff,
2005,
2007,
2008;
Wieringa,
1999,
2012).
Blackwood
(1998)
has
focused
on
the
construction
of
masculinity
and
erotic
desire
among
tombois
in
West
Sumatra;
Blackwood
(2005)
has
examined
how
lesbi
in
West
Sumatra
access
and
appropriate
the
discourses
of
the
global
queer
movement
to
shape
their
gendered
and
sexual
subjectivities.
Boellstorff
(2005)
has
addressed
how
transvestites
in
Indonesia
experience
disso-
nance
between
their
male
bodies
and
female
jiwa
(souls),
while
Wieringa
(2012)
has
discussed
some
of
the
major
symbolic
forms
of
subverting
heteronormativity
in
Indonesia.
Members
of
Indonesia’s
diverse
male-to-female
transgen-
der
community
often
describe
themselves
as
waria
–
derived
from
the
words
wanita
(woman)
and
pria
(man).
Waria
are
“male
bodied
individuals
who
act
like
women
and
take
men
as
lovers”
(Blackwood,
2005,
p.
233).
Although
waria
usu-
ally
have
sex
with
‘real’
men,
they
are
not
seen
as
gay
(
Boellstorff,
2005).
Bodily
presentation
appears
more
important
than
sexual
acts
in
asserting
femininity
(Boellstorff,
2005).
Most
http://dx.doi.org/10.1016/j.drugpo.2014.06.012
0955-3959/©
2014
The
Authors.
Published
by
Elsevier
B.V.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(http://creativecommons.org/licenses/by-nc-nd/3.0/).

790
N.I.
Idrus,
T.D.
Hymans
/
International
Journal
of
Drug
Policy
25
(2014)
789–797
waria
begin
identifying
as
such
while
they
are
(young)
chil-
dren.
“Warias
do
not
equate
being
feminine
with
being
female”
(
Boellstorff,
2007,
p.
92).
Our
research
in
three
urban
sites
in
Indonesia
confirms
that
–
like
the
travesti
Kulick
(1998)
studied
in
Brazil
–
waria
do
not
want
to
be
women.
They
instead
aspire
to
be
like
women
(seperti
perempuan).
This
entails
cultivating
manner-
isms
as
well
as
‘covering
up’
masculine
traits,
here
associated
with
the
notion
of
dandan
–
to
be
made
up,
wearing
women’s
clothes,
shaving
one’s
legs
and
styling
one’s
hair
(see
Boellstorff,
2008).
And
as
we
found
out
in
the
course
of
our
research,
some
waria
go
further
in
their
practices
of
transforming
their
bodies.
Before
the
1970s,
waria
could
only
strive
to
feminize
their
bodies
through
the
use
of
‘traditional’
medicines
and
by
inserting
padding
under
their
blouses.
Nowadays,
more
permanent
means
of
bodily
transformation
are
available
(cf.
Sanabria,
2013),
including
the
ingesting
and
injecting
of
female
hormones,
surgical
interventions
involving
silicone,
and
in
the
rarest
of
cases,
sex-change
operations
(
Boellstorff,
2007,
p.
94).
The
current
article
is
an
in-depth
explo-
ration
of
contemporary
practices
of
self-administered,
chemically
assisted
bodily
transformation
among
a
group
of
30
waria
youths,
spread
across
three
sites
in
Indonesia.
The
ideal
mark
of
femininity
in
Indonesia,
many
have
claimed,
is
to
have
well-formed
breasts
and
light
skin,
for
which
women
use
a
variety
of
chemical
products.
Indeed,
having
smooth,
fair
skin
and
beautiful
breasts
emerged
as
major
preoccupations
among
the
waria
we
interviewed
in
all
three
of
our
field
sites.
To
achieve
these
ends,
they
experiment
with
various
contraceptive
hormones
(both
pills
and
injections)
and
skin-whitening
products
(includ-
ing
those
containing
potentially
harmful
ingredients),
finding
the
dosages
and
products
that
work
best
for
them.
While
most
of
our
informants
were
fairly
happy
with
the
immediate
results,
they
con-
tinuously
experience
severe
side-effects.
And
while
they
develop
strategies
to
minimize
the
side-effects,
at
least
some
of
our
infor-
mants
did
not
expect
to
live
long
(cf.
Suja,
Sutanyawatchai,
&
Siri,
2005
).
Following
a
brief
outline
of
our
methods,
we
turn
to
the
detailed
description
of
the
practices
of
body-shaping
and
skin-whitening
that
we
observed
in
our
field
sites,
focusing
on
the
products
used
by
our
informants
and
their
pervasive
experimentation
to
find
the
(combinations
of)
products
that
are
most
cocok
(compatible)
with
their
individual
bodies.
This
is
followed
by
reflection
on
how
these
practices
spread,
pointing
to
the
social
contexts
of
chemically
assisted
bodily
transformation
in
our
field
sites.
In
the
conclusion,
we
touch
upon
what
our
findings
imply
for
existing
harm
reduction
programmes
in
Indonesia
and
beyond.
Methods
Our
field
research
took
place
in
Makassar,
the
capital
city
of
South
Sulawesi;
in
a
smaller
town
in
the
regency
of
Bulukumba
on
the
south
coast
of
Sulawesi;
and
in
the
special
region
of
Yogyakarta
in
Java.
NGOs
were
involved
in
the
recruitment
of
our
informants:
Yayasan
Gaya
Celebes
in
Makassar,
Wakerba
in
Bulukumba,
and
Kebaya
in
Yogyakarta.
Waria
in
Makassar
are
more
loosely
orga-
nized
and
were
harder
to
contact.
The
fact
that
we
were
often
introduced
to
our
informants
through
self-organized
groups
of
waria
introduces
the
possibility
of
significant
selection
bias.
We
do
not
claim
our
findings
to
be
representative
for
waria
in
South
Sulawesi
or
Yogyakarta,
much
less
for
waria
across
Indonesia.
We
pursued
research
in
these
three
sites
to
see
if
the
chemical
use
practices
that
we
observed
were
localized
or
geographically
widespread.
Data
were
collected
through
repeated
in-depth
interviews
with
ten
waria
youths
aged
between
18
and
26
in
each
site
(30
in
total);
Fig.
1.
The
most
popular
brands
for
pills
and
injections.
Photographer:
Nurul
Ilmi
Idrus.
interviews
with
pharmacists,
drug
and
cosmetics
store
clerks;
three
focus
group
discussions
at
each
site;
and
participant
observation.
We
began
our
focus
groups
with
drug
recalls
to
obtain
data
on
the
chemical
products
consumed
over
the
preceding
four
days,
dosages,
costs,
length
of
use,
desirable
and
adverse
effects,
and
any
perceived
long-term
risks.
We
used
NVivo
10
to
analyse
the
data.
We
began
by
identify-
ing
themes
in
the
interview
transcripts
to
make
a
coding
scheme.
Subsequent
text-search
queries
using
NVivo
facilitated
the
iterative
analysis
of
the
data.
All
participants
in
our
research
gave
their
voluntary
written
consent
after
we
explained
our
research
objectives.
We
received
ethical
clearance
from
the
University
of
Amsterdam
as
well
as
offi-
cial
letters
from
provincial
and
local
authorities
to
conduct
research
in
their
jurisdictions.
All
names
in
this
article
are
pseudonyms.
Although
we
recognize
that
other
scholars
have
used
different
ter-
minology,
we
have
chosen
to
use
“she”
and
“her”
when
referring
to
gender
transgressing
individuals.
Body
shaping
Many
of
our
waria
informants
took
contraceptive
hormones
meant
for
women
to
reshape
their
bodies.
By
ingesting
or
injecting
hormones
directly
into
their
chests,
thighs
and
arms,
they
sought
secondary
beneficial
effects
such
as
smoother
skin,
the
elimination
of
visible
veins
and
reduced
muscle
mass.
Unlike
the
Brazilian
trav-
esti
studied
by
Kulick
(1998)
who
sought
to
physically
transform
their
chests,
buttocks
and
thighs,
our
informants
mostly
wanted
to
have
breasts
like
women.
This
first
entailed
creating
a
base
(dasar)
containing
hard
tissue
(batu)
for
our
informants
in
Makassar
and
Bulukumba,
and
a
pocket
(kantong)
to
form
their
breasts
for
our
informants
in
Yogyakarta.
Contraceptive
pills
and
injections
were
the
favoured
means
to
form
breasts
among
our
informants
in
Makassar
and
Bulukumba.
Their
initial
concern
was
to
form
the
base
containing
hard
tissue
so
that
their
breasts
would
grow
in
the
right
place.
They
then
turned
to
high
dosages
of
injected
hormones
to
grow
their
breasts,
followed
by
lower
dosages
of
contraceptive
pills
or
injections
to
maintain
them.
Many
of
our
informants
in
Yogyakarta,
sick
of
taking
regular
pills
or
injections,
favoured
silicone
breast
implants.
But
regard-
less
of
whether
they
used
hormones
or
silicone,
our
informants
all
stressed
that
they
first
needed
to
use
hormones
to
form
a
pocket
to
position
their
breasts.
Becoming
more
feminine
was
thus
a
gradual
process
(Fig.
1).
Our
informants
experimented
with
Andalan,
Marvelon,
Micro-
dion,
Microgynon
and
Trinordiol
brand
contraceptive
pills
as
well
as
Andalan
and
Cyclofem
injections.
Andalan
and
Marvelon
were
the
most
popular
pills;
Cyclofem
was
the
most
popular
injection,
though
Andalan
(on
the
market
for
breastfeeding
women)
was

N.I.
Idrus,
T.D.
Hymans
/
International
Journal
of
Drug
Policy
25
(2014)
789–797
791
Table
1
Contraceptive
products
used
to
feminize
bodies.
Product
Manufacturer/licence
Content
Product
information
Andalan
pill
Marketing:
DKT
Indonesia
Each
tablet
contains:
0.15
mg
Levonolgestrel
0.03
mg
Ethinylestradiol
Begin
taking
on
the
first
day
of
menstruation
Manufacturer:
PT
Sydna
Farma,
Jakarta,
Indonesia
Indication:
low
dosage
oral
contraceptive
for
breast-feeding
mothers
License:
NV
Organon,
Netherlands
By
prescription
only
Marvelon
28
pill
Marketing:
DKT
Indonesia
Each
pack
consists
of
21
large
tablets,
each
containing:
0.150
mg
Desogestrel
0.030
mg
Ethinylestradiol
No
active
ingredient
in
the
small
tablets
By
prescription
only
Manufacturer:
PT
Sydna
Farma,
Jakarta,
Indonesia
License:
NV
Organon,
Netherlands
Trinordiol
pill
Manufacturer:
Wyeth,
Germany
&
Republic
of
Ireland
Each
light
brown
tablet
contains:
0.03
mg
Ethinylestradiol
0.05
mg
Levonorgestrel
Synthetic
oestrogen
and
Levonorgestrel
is
a
synthetic
form
of
progesterone
Each
white
tablet
contains:
0.04
mg
Ethinylestradiol
0.075
mg
Levonorgestrel
Each
ochre
tablet
contains:
0.03
mg
Ethinylestradiol
0.125
mg
Levonorgestrel
Each
21-day
pack
contains
three
types
of
tablets
(six
light
brown,
five
white,
ten
ochre),
each
with
a
slightly
different
hormone
dosage
Microgynon
pill
Manufacturer:
Schering
do
Brasil
Quimica
Farmaceutica
Ltda,
Sao
Paolo,
Brazil
21
Sugar-coated
tablets,
each
containing:
0.15
mg
Levonorgestrel
0.03
mg
Ethinylestradiol
7
Sugar-coated
tablets,
each
containing
48.25
mg
Lactosa
By
prescription
only
Importer:
PT
Bayer
Indonesia
Microdiol
30
pill
Manufacturer
and
distributor:
Kimia
Farma
Indonesia
Each
small
tablet
contains:
0.150
mg
Levonorgestrel
0.030
mg
Ethinylestradiol
No
active
ingredient
in
the
large
tablets
By
prescription
only
Cyclogynon
pill
Marketing:
PT
Tunggal
Idaman
Abdi,
Indonesia
Each
tablet
contains:
0.15
mg
Levonorgestrel
0.03
mg
Ethinylestradiol
Manufacturer:
PT
Sunthi
Sepuri,
Indonesia
Andalan
Laktasi
pill
KB
Marketing:
DKT
Indonesia
Each
tablet
contains:
0.15
mg
Levonorgestrel
0.03
mg
Ethinylestradiol
By
prescription
only
Manufacturer:
PT
Sydna
Farma,
Indonesia
License:
NV
Organon,
Netherlands
Andalan
contraceptive
injection Manufacturer:
Harsen,
Indonesia,
incorporated
under
DKT
Indonesia
Each
1
ml
contains:
150
mg
Medroxyprogesterone
acetate
By
prescription
only
Sterile
suspension
of
Medroxyprogesterone
acetate
in
water
Cyclofem
contraceptive
injection
Manufacturer:
PT
Tunggal
Idaman
Abdi,
Indonesia
Each
vial
contains:
25
mg
Medroxyprogesterone
acetate
5
mg
Estradiol
USP
sterilized
micronized
By
prescription
only
License:
Concept
Foundation,
Thailand
also
seen
as
highly
effective.
The
popularity
of
these
brands
was
confirmed
by
a
number
of
chemists
whom
we
interviewed.
Many
said
that
contraceptive
pills
work
faster
than
injections
(but
see
Sanabria,
2013).
Most
began
with
brands
mentioned
by
their
waria
peers,
by
a
midwife
(bidan),
or
more
seldom,
by
family
members.
Some
pills
were
prescription
only;
others
were
not.
Either
way,
they
were
freely
available
over
the
pharmacy
counter.
Table
1
shows
the
products
used
by
our
informants
along
with
their
manufacturers,
chemical
content
and
product
information.
Our
informants
experimented
with
dosages
to
see
what
works
best,
consuming
anywhere
between
1
and
21
contraceptive
pills
per
day.
Imas
from
Bulukumba
began
by
taking
one
pill
a
day,
the
prescribed
dosage
for
‘ordinary
women’.
After
finishing
a
strip
of
pills
and
experiencing
pain
in
her
breasts
and
penis,
she
changed
to
monthly
contraceptive
injections,
three
times
the
normal
pre-
scribed
dosage
(Table
2).
Some
of
our
informants
experimented
with
much
heavier
dosages.
Anti
from
Bulukumba
took
five
Andalan
pills
twice
a
day
for
almost
two
years.
Her
friend
Nindi
took
seven
pills
three
times
a
day,
while
Mince
from
Makassar
had
six
contraceptive
injec-
tions
over
a
period
of
three
weeks.
The
belief
is
that
the
higher
the
dosage,
the
greater
and
faster
the
effect.
Problems
ensued,
however,
when
our
informants
lowered
dosages
to
maintain
their
breasts;
their
breasts
then
shrank,
necessitating
higher
dosages
again.
Citra
Table
2
Contraceptive
dosages.
Women
(prescribed)
Waria
(off-label)
Pills
One
per
day
1–21
per
day
Injection
Once
a
month
or
every
three
months
Twice
a
week
to
once
every
three
months

792
N.I.
Idrus,
T.D.
Hymans
/
International
Journal
of
Drug
Policy
25
(2014)
789–797
experimented
with
weekly
injections
which
provided
quick
results,
but
had
to
continue
injections
at
the
same
dosage
to
maintain
the
shape
of
her
breasts.
Our
informants
believed
that
in
the
process
of
growing
breasts,
certain
foods
and
drinks
had
to
be
avoided
so
that
the
hormones
would
have
their
full
effect.
Cece
from
Yogyakarta
avoided
drinking
cold
water
and
soft
drinks.
Anti
from
Bulukumba
was
warned
by
her
peers
not
to
eat
spicy
or
sour
food,
while
Ade
from
Yogyakarta
was
advised
not
to
consume
alcohol.
Growing
and
maintaining
breasts
was
not
just
a
question
of
taking
hormones,
but
concerned
brands,
dosages,
modes
of
administration,
and
diet.
Switching
and
combining
hormones
Our
informants
often
switched
between
or
combined
hormonal
products.
Some
stayed
with
one
brand;
others
experimented
with
different
brands
to
see
which
were
most
cocok
with
their
individual
bodies.
How
the
products
influenced
their
outward
appearance
was
a
major
consideration;
negative
side-effects
were
often
tolerated
if
outward
appearance
was
not
adversely
affected.
Others
stopped
using
certain
products
when
they
could
no
longer
tolerate
their
side-effects.
The
effects
of
hormones
differed
between
individuals.
The
beneficial
effects
reportedly
included
the
growth
of
breasts,
hair
fall-out
(i.e.
body
hair),
smoother
skin,
the
reduction
of
muscle
mass,
the
elimination
of
pimples,
a
glowing
face
and
firmer
but-
tocks.
Among
the
adverse
effects,
our
informants
reported
nausea,
dizziness,
drowsiness,
pimples,
red
facial
spots,
constipation,
diar-
rhoea,
feeling
sluggish
and
bloated.
Table
3
shows
the
desired,
beneficial
and
adverse
effects
of
each
brand
mentioned
by
our
infor-
mants.
Some
of
our
informants
reported
no
side-effects.
Citra
from
Makassar
noted
that
Andalan
pills
made
her
breasts
grow
with-
out
adverse
effects.
Others
switched
between
pills
and
injections
to
see
what
best
fit
their
individual
bodies.
Mince
from
Makas-
sar
began
with
pills,
shifted
to
injections,
then
reverted
to
pills
again.
Andalan
pills
made
her
dizzy,
nauseous,
sleepy
and
lazy;
she
gained
weight
and
could
not
work.
She
then
tried
Cyclofem
injections.
When
she
achieved
her
desired
results
–
less
mus-
cle
mass,
firm
buttocks
and
growing
breasts
–
she
reverted
to
pills,
this
time
Marvelon,
explaining
that
once
the
body
is
shaped,
pills
can
effectively
maintain
the
results.
Though
she
experienced
muscle
pain,
she
stayed
with
Marvelon.
Pain
that
did
not
affect
her
appearance
was
acceptable;
weight
gain
was
not.
Anti
from
Bulukumba
reported
that
even
though
Andalan
pills
made
her
breasts
grow,
eliminated
visible
veins
and
made
her
skin
smooth,
she
turned
to
injections
because
she
could
not
tolerate
the
nausea.
She
finally
also
stopped
with
the
injections
because
they
made
her
fat.
Some
of
our
informants
turned
to
padded
bras
because
they
could
not
tolerate
the
adverse
effects
of
hormonal
products.
Lili,
a
sex
worker
from
Makassar,
stopped
using
injections
as
she
expe-
rienced
great
pain
in
the
hard
tissue
forming
under
her
breasts,
especially
when
clients
squeezed
them.
Cantik,
Cece,
Yeni
and
Ade
from
Yogyakarta
likewise
preferred
padded
bras
to
contraceptive
pills
or
injections.
Both
options,
they
said,
are
in
any
case
fake.
They
instead
desired
silicone
injections,
which
they
saw
as
a
more
per-
manent
solution.
While
Cantik,
Cece
and
Yeni
dreamed
of
silicone,
Ade
had
already
injected
250
cc
into
each
breast.
She
was
too
impa-
tient
to
wait
for
the
effects
of
the
Microgynon
pills
which
made
her
feel
limp
and
sleepy.
Waria
who
are
growing
breasts
enjoy
greater
respect
and
legitimacy;
the
padded
bra
remains
the
object
of
jokes
and
derision.
Other
informants
tolerated
the
side-effects
of
taking
hormones,
believing
them
to
be
signs
of
efficacy.
Imas
from
Bulukumba
shifted
from
contraceptive
pills
to
injections
as
she
experienced
pain
in
her
breasts,
one
of
the
noted
side-effects
of
Lynestrenol
contained
in
the
Andalan
pill.
It
was
commonly
believed,
however,
that
pain
in
one’s
breasts
means
they
are
beginning
to
grow.
Pain
is
thus
evidence
of
transformation.
Although
Imas
was
afraid
of
injections,
she
continued
with
them
in
the
hope
of
having
larger
breasts
in
the
future.
Some
of
our
informants
combined
pills
and
injections.
Tenri
from
Makassar
took
pills
twice
a
day
and
an
injection
once
a
week
to
speed
up
the
growth
of
her
breasts.
Since
she
felt
shivery
when
she
took
the
pills,
she
usually
took
them
with
a
hot
cup
of
coffee.
Susi
from
Bulukumba
said
she
began
with
pills
to
grow
her
breasts
and
later
combined
pills
with
an
injection
every
three
months
to
eliminate
her
visible
veins.
Others
experimented
with
even
more
aggressive
regimes,
switching
brands
to
find
which
was
most
cocok,
increasing
dosages
and
combining
pills
with
injections
that
targeted
specific
parts
of
their
bodies.
Oci
from
Makassar
began
with
Marvelon
pills
and
then
switched
to
Microdion,
Trinordiol,
Microgynon
and
Andalan,
each
having
a
different
effect.
She
finally
chose
Trinordiol
because
its
side-effects
–
nausea
and
constipation
–
are
invisible,
while
other
brands
led
to
pimples
or
red
spots
on
her
face.
She
started
by
taking
three
pills
a
day;
after
a
week
she
increased
the
dosage
to
five
pills.
Feeling
that
pills
were
cocok,
she
increased
her
dosage
to
seven
pills
a
day,
which
became
her
regular
dosage
combined
with
a
weekly
injection
(she
believes
injections
on
their
own
provide
slow
results).
Tenri
from
Makassar
confirmed
the
efficacy
of
pills:
‘When
we
took
pills,
the
hormone
accumulated
in
our
chest
(terkumpul
di
dada)’.
Does
size
matter?
Some
of
our
informants
stopped
taking
hormones
because
the
growth
of
breasts
was
minimal.
Uci
from
Yogyakarta
told
us
she
wants
breasts
but
does
not
use
contraceptive
hormones.
The
lat-
ter
do
not
lead
to
beautiful
breasts,
she
said,
but
to
‘grandmother
breasts’
like
hanging
saucers.
Though
she
knew
that
taking
hor-
mones
can
have
other
benefits
such
as
eliminating
visible
veins,
she
was
afraid
of
their
side-effects.
Uci
wanted
breast
implants
instead.
But
since
she
cannot
afford
them,
she
wants
to
find
a
Western
part-
ner
who
can.
Imas
from
Bulukumba
told
us
that
high
dosages
of
injected
contraceptives
only
had
a
minimal
effect,
giving
her
the
breasts
of
a
12
year-old
girl.
Yeni
from
Yogyakarta
discontinued
taking
Microgynon
pills
after
six
months.
Even
though
she
attained
her
desired
effects
(reduced
muscle
mass
and
visible
veins),
her
breasts
grew
only
slightly.
Yeni
was
afraid
of
trying
injections
because
she
was
told
they
have
strong
adverse
effects;
she
turned
to
a
padded
bra
instead.
Though
breast
size
was
important,
it
was
never
specified
just
how
large
they
had
to
be.
None
of
our
informants
aspired
to
have
very
large
breasts.
The
most
important
thing
was
to
have
breasts
at
all
–
a
sign
of
having
a
feminine
body.
Mimi,
a
50
year-old
head
of
a
boarding
school
for
waria
in
Yogyakarta
and
a
beauty
salon
owner,
disagreed
about
the
dan-
gers
of
using
hormones.
As
long
as
they
are
used
cautiously
and
cheap
products
are
avoided,
she
said,
there
will
be
no
problems.
She
pointed
to
her
own
well-developed
breasts
which
she
has
had
for
over
20
years;
she
first
used
contraceptive
pills
to
form
the
kan-
tong
and
then
travelled
to
Jakarta
for
silicon
injections.
Although
she
disapproves
of
surgical
breast
implants
due
to
her
friend’s
failed
experience,
she
had
plastic
surgery
for
her
nose.
In
Surabaya
we
met
Pretty,
a
beauty
salon
owner
with
breast
implants.
We
heard
stories
that
both
Mimi
and
Pretty
not
only
sell
cheap
silicon
products
behind
the
scenes,
but
also
inject
them
for
their
clients.
Nevertheless,
Mimi
and
Pretty
blamed
those
who
failed
to
attain
well-developed
breasts
for
wanting
good
and
instant
results
with
cheap
products.
Beauty
is
expensive,
they
said.

N.I.
Idrus,
T.D.
Hymans
/
International
Journal
of
Drug
Policy
25
(2014)
789–797
793
Table
3
Effects
of
hormones.
Product
brands
Desired
effects
Beneficial
effects
Adverse
effects
Andalan
pill
Growing
breasts
Growing
breasts,
thinning
body
hair,
smoothing
skin,
eliminating
visible
veins
Continuous
diarrhoea,
sleepiness,
feeling
limp
and
dizzy,
feeling
like
vomiting,
gaining
weight,
lacking
sexual
desire
Marvelon
pill
Growing
breasts
Growing
breasts,
glowing
face,
good
skin
Pimples,
feeling
dizzy,
hair
fallout,
gaining
weight
around
nose,
red
facial
spots,
shivering
Microdiol
pill
Growing
breasts
Growing
breasts
Red
facial
spots
Microgynon
pill
Growing
breasts
Growing
breasts,
eliminating
muscle,
eliminating
visible
veins
Red
facial
spots,
feeling
limp
Cyclogynon
pill Growing
breasts Growing
breasts Gaining
weight
Trinordiol
pill
Growing
breasts
Growing
breasts,
eliminating
pimples
Nausea,
constipation
Andalan
Lactacy
pill
Growing
breasts
Fast
growing
breasts
Watery
breasts,
hair
fallout
Diane
35
pill
Growing
breasts
Growing
breasts,
smoothing
skin,
eliminating
muscle
Feeling
lazy,
becoming
fat,
increased
appetite,
headache,
lacking
sexual
desire
Andalan
contraceptive
injection
Growing
breasts,
eliminating
visible
veins
Shrinking
muscle
Nausea,
constipation,
feeling
dizzy,
gaining
weight,
feeling
limp
Cyclofem
contraceptive
injection
Growing
breasts,
eliminating
muscle
Shrinking
muscle,
beautifying
body,
growing
breasts,
lifting
up
behind
Pimples,
deafness,
hair
fallout,
red
facial
spots,
pain
Hormones
and
sex-related
effects
Kosenko
(2011)
has
found
that
taking
hormones
has
a
noticeable
impact
on
the
sexual
thoughts
and
behaviour
of
both
male-to-
female
and
female-to-male
transsexuals.
Among
male-to-female
individuals,
hormones
tend
to
diminish
sexual
appetite.
In
our
group
discussions,
our
informants
discussed
how
taking
female
hormones
affected
the
functioning
of
their
male
organs.
Nindi
from
Bulukumba
switched
from
pills
to
injections
when
she
could
no
longer
achieve
an
erection.
Susi
from
Bulukumba
explained
that
before
using
hormones,
her
penis
would
erect
whenever
she
saw
a
man.
Though
she
is
no
longer
taking
hormones,
she
can
no
longer
achieve
a
full
erection,
though
this
has
not
affected
her
desire
to
have
sex
with
men.
She
believes
taking
contraceptive
pills
has
‘turned
off’
her
testosterone,
though
she
can
still
have
orgasms.
The
focus
groups
revealed
differences
in
sexual
expectations
among
our
informants
(cf.
Winter,
2012).
Some
thought
the
ability
to
sustain
erections
was
crucial,
with
the
ability
to
satisfy
partners
through
penetration
and
be
satisfied
through
oral
sex
remaining
an
important
part
of
their
sexual
lives.
Indah,
a
sex
worker,
had
stopped
using
pills
because
her
‘Mr.
P’
could
not
turn
on
for
her
own
and
her
client’s
sexual
pleasure.
Hetti
felt
that
hormones
make
her
body
‘boneless’:
her
penis
had
‘shrunk’
and
‘could
not
stand
up’.
In
contrast,
one
of
the
participants
in
a
group
discussion
in
Bulukumba
was
proud
of
her
‘dead
penis’,
which
she
invited
us
to
touch.
Still
others
proudly
proclaimed
lebih
besar
mama
dari
pada
papa
(my
penis
is
bigger
than
my
partner’s).
Our
informants
were
aware
that
ingesting
hormones
has
long-
term
effects.
Many
feared
that
they
would
die
young.
Nevertheless,
to
become
like
women
was
more
important
than
their
health
so
the
risks
were
worthwhile.
Yuli
from
Yogyakarta
was
perhaps
excep-
tional.
She
did
not
want
to
use
hormones,
believing
that
products
for
external
use
were
safer.
Her
preference
to
use
a
padded
bra,
she
felt,
did
not
diminish
her
waria
‘soul’.
Whitening
beauty
In
addition
to
growing
breasts,
our
informants
also
expressed
a
general
desire
to
have
lighter
complexions.
Having
‘white
skin’
was
assumed
to
be
more
attractive
than
having
dark
skin,
and
was
associated
with
femininity.
‘Whitening’
their
skin
was
thus
one
way
to
become
‘like
women’.
All
of
our
informants
saw
skin-whitening
as
a
way
to
attract
or
maintain
male
attention;
they
clearly
believed
that
men
–
potential
boyfriends,
partners
or
clients
in
the
case
of
sex
workers
–
prefer
women
with
light
skins
(see
Idrus
and
Hardon,
under
review;
cf.
Ashikari,
2005).
Our
informants
used
many
different
skin-whitening
prod-
ucts.
The
strongest
were
exfoliating
products
containing
Tretinoin
and
Hydroquinone.
Twenty-seven
products
containing
Tretinoin
and
20
containing
Hydroquinone
are
registered
as
medicines
in
Indonesia,
most
of
them
manufactured
by
Indonesian
companies.
According
to
Informasi
Spesialite
Obat
Indonesia
(AIA,
2012),
some
of
these
products
require
prescriptions.
The
product
labels
state
that
Tretinoin
and
Hydroquinone
are
skin
whitening
exfoliants
and
anti-acne
depigmenting
agents.
Our
informants
also
reported
using
skin
creams
containing
Vita-
min
E,
Ginseng,
Aloe
Vera,
Hydrolized
Pearl
and
Allantoin
as
well
as
various
powders,
foundations,
soaps,
hand
and
body
lotions
and
scrubs.
Powders
and
foundations
were
used
to
cover
their
faces;
hand
and
body
lotions
and
scrubs
to
whiten
their
bodies.
Some
even
used
foundations
and
creams
to
cover
the
dark
skin
on
their
arms
and
legs.
Perhaps
due
to
their
geographical
proximity,
our
informants
in
Makassar
and
Bulukumba
reported
using
the
same
products.
They
also
reported
using
more
aggressive
products
than
our
informants
in
Yogyakarta,
where
we
came
across
fewer
exfoliating
products
and
creams,
and
only
relatively
mild
face
soaps,
lotions
and
scrubs.
Table
4
shows
which
products
were
mentioned
where,
the
poten-
tial
harmful
ingredients
in
each
product,
and
their
potential
adverse
effects.
Our
interviews
revealed
exfoliating
products
and
creams
to
be
the
strongest
and
mostly
commonly
used
skin-whitening
products.
A
cosmetics
store
clerk
in
Bulukumba
explained
that
these
products
give
‘instant’
results
but
have
strong
side-effects.
In
contrast,
other
popular
products
such
as
Ponds
have
no
side-effects,
but
are
slow
to
show
results.
A
cosmetics
retailer
in
Makassar
reported
that
alongside
papaya
soap
and
Bali
scrub,
SJ,
Diamond
and
UB
are
the
most
popular
creams
sold
in
her
store
(see
Table
4
for
product
contents).
She
said
that
some
of
the
creams
are
palsu
(fake),
merely
re-labelled
versions
of
cheaper
products.
The
retailer
sells
them
at
similar
prices,
given
that
there
is
demand
and
customers
report
that
they
are
cocok
for
them.
A
shopkeeper
in
a
Yogyakarta
cosmetics
store
told
us
that
products
such
as
Ling
Zhi
and
Walet
creams
are
not
placed
in
the
glass
showcase
because
‘they
are
too
small’.
We
suspect
they
were
hiding
non-registered
products
in
anticipation
of
sudden
inspec-
tions
by
Badan
POM,
the
Drug
and
Food
Control
Agency
(Fig.
2).
Our
interviews
and
focus
groups
revealed
three
ways
in
which
our
informants
whiten
their
skin:
with
exfoliating
liquids,
with
skin
creams,
and
with
powders
and
foundations.

794
N.I.
Idrus,
T.D.
Hymans
/
International
Journal
of
Drug
Policy
25
(2014)
789–797
Table
4
Popular
skin-whitening
products.
Brand
of
exfoliating
liquid
and
facial
cream
Makassar
Bulukumba
Yogyakarta
Potentially
harmful
ingredients
Potential
adverse
effects
RDL
√√
–
Hydroquinone,
Tretinoin
Decrease
production
of
melanin,
increase
exposure
to
UVA
and
UVB,
increase
risks
of
skin
cancer
Maxi
Peel
√
√
–
Hydroquinone,
Tretinoin
Decrease
production
of
melanin,
increase
exposure
to
UVA
and
UVB,
increase
risks
of
skin
cancer
Maxi
White
√
√
–
Hydroquinone,
Tretinoin
Decrease
production
of
melanin,
increase
exposure
to
UVA
and
UVB,
increase
risks
of
skin
cancer
Diamond
cream
√
√
–
Not
provided
Feeling
hot
on
skin,
drying,
exfoliating
UB
ginsara
herbal
pearl
cream
√
√
–
Allantoin
Irritation,
stinging,
redness
and
burning
SJ
day
and
night
cream
√
√
–
Triethanolamine
Itching
and
burning
Methylparaben
Increase
skin
aging
and
DNA
damage
Isopropyl
myristate
Cracks
and
fissures
SP
cream
√
√
–
Petrolatum
Feels
hot
on
skin
Maxi
Peel
bleaching
pearl
cream
Not
provided
Redness
Quina
ginseng
pearl
cream
√√
–
Propylparaben
Skin
irritation,
itchiness
and
redness
Quint’s-yen
cream
√√
–
Propylparaben
Skin
irritation,
itchiness
and
redness
Methylparaben
Increase
skin
aging
and
DNA
damage
Kelly
pearl
cream
√
√
√
Isopropyl
myristate
Cracks
and
fissures
Propylparaben
Skin
irritation,
itchiness
and
redness
Krayolan
cream
√√ √
Walet
2
in
1
super
whitening
cream
–
–
√
Dimenthicone
Skin
irritation,
burning,
stinging,
redness
Ling
Zhi
day
and
night
cream
–
–
√
Tocopheryl
leukocyte
extract
Skin
irritation,
redness,
rashes,
allergic
reaction
Exfoliating
products
Exfoliating
is
the
fastest
and
most
intrusive
way
to
lighten
one’s
skin.
The
use
of
exfoliating
liquids
was
only
reported
by
our
infor-
mants
in
Makassar
and
Bulukumba,
commonly
used
with
night
and
day
creams
as
well
as
papaya
soap.
They
began
by
cleansing
their
skin
with
face
soap
then
applying
the
alcohol
liquid,
stating
that
the
creams
are
to
counter
the
liquid’s
strong
side-effects
(Fig.
3).
Our
informants
often
associated
the
efficacy
of
exfoliating
prod-
ucts
with
their
side-effects,
many
of
them
negative
and
alarming.
These
included
reddish,
painful,
hot
and
burning
skin.
Participants
in
a
group
discussion
in
Makassar
found
the
exfoliating
liquid
RDL
to
be
stronger
than
Maxi
Peel.
While
the
end
result
of
using
RDL
was
‘smooth,
clean
and
white’
skin,
the
process
to
arrive
there
entailed
suffering
‘hot,
itchy,
and
reddish’
skin.
Oci
from
Makassar
ended
up
using
RDL
after
discontinuing
Diamond
cream
because
it
burned
her
skin
and
gave
her
pimples.
While
RDL
solved
her
pimple
Fig.
2.
A
shelf
in
a
market
cosmetics
stall
in
Makassar.
Photographer:
Nurul
Ilmi
Idrus.
problem,
her
face
turns
red
if
she
goes
out
in
the
sun.
Lili
complained
that
RDL
is
hotter
than
chilli.
These
effects,
however,
were
believed
to
be
signs
that
the
desired
result
was
being
achieved.
‘Beauty
pain’
thus
hardly
mattered.
Transformation
literally
means
peeling
away
the
old
(male)
skin
to
reveal
the
new
self.
Many
of
our
informants
devised
ways
to
manage
the
harsh
effects
of
exfoliating
products.
Titi
from
Makassar
stated
about
Maxi
White:
‘It’s
very
hot,
almost
every
night
I
rub
gently
with
an
ice
block.
.
.
it
feels
like
a
knife
cutting
my
face
and
I
usually
stand
in
front
of
the
fan.’
Citra
used
the
products
only
at
night
to
lessen
the
heat
and
to
avoid
the
reddening
effect
of
the
sun.
Some
said
they
only
used
exfoliating
products
occasionally.
Cici
from
Bulukumba
used
RDL
only
when
she
had
pimples.
Manis
used
Maxi
Peel
to
‘refresh’
(menyegarkan)
her
skin
only
when
it
grew
dark.
Creams
Creams
were
another
way
to
lighten
one’s
complexion.
Some
of
our
informants
used
different
day
and
night
creams;
others
switched
products
until
they
found
the
one
most
suitable
for
them.
Some
stopped
using
products
when
they
had
attained
their
desired
result;
the
effects,
however,
soon
disappeared.
Some
reported
that
after
stopping
with
the
product,
their
skins
were
darker
than
before.
Others
stopped
because
they
could
not
tolerate
the
adverse
effects.
Fig.
3.
Exfoliating
products.
Photographer:
Nurul
Ilmi
Idrus.

N.I.
Idrus,
T.D.
Hymans
/
International
Journal
of
Drug
Policy
25
(2014)
789–797
795
Fig.
4.
Cream
products
containing
potentially
harmful
ingredients.
Photographer:
Nurul
Ilmi
Idrus.
In
Makassar,
our
interviews
revealed
the
popularity
of
the
Diamond
brand.
This
was
confirmed
by
a
cosmetics
retailer
in
a
Makassar
market
who
told
us
that
she
sells
more
Diamond
skin-whitening
cream
than
any
other
brand.
Exfoliating
products
containing
Hydroquinone
and
creams
such
as
Diamond
are
regis-
tered
by
Badan
POM.
Other
cream
products,
such
as
SJ
(containing
Triethanolamine,
Methylparabon
and
Isoprophyl
Miristate)
and
SP
(containing
Petrolatum),
can
be
fake
or
authentic.
The
latter
have
a
registration
number
and
the
Badan
POM
stamp
on
their
packaging
(
Fig.
4).
The
effects
of
using
creams
differed
among
our
informants.
Some
attained
lighter
complexions
without
adverse
effects.
Manis
from
Bulukumba
reported
that
Diamond
cream
worked
faster
than
the
other
brands
she
had
tried.
Anti
found
that
Diamond
cream
not
only
whitened
her
skin,
but
also
made
her
skin
look
more
natural
(alami).
Others
did
not
entirely
attain
their
desired
result
but
con-
tinued
using
products
due
to
their
positive
side-effects.
Fera
from
Makassar
stated
that
although
Diamond
cream’s
whitening
effect
is
minimal,
its
skin-smoothening
effect
is
significant.
Endah
from
Makassar
likewise
reported
that
Diamond
cream
does
more
than
make
her
face
white
–
it
makes
her
face
shine.
Its
adverse
effects
could
therefore
be
tolerated.
Yeni
from
Yogyakarta
previously
used
Placenta
cream
but
could
not
tolerate
its
adverse
effects,
among
them
inflamed
skin.
She
turned
to
a
facial
wash
and
cream
concocted
by
Dr.
Jenong,
a
dermatologist
popular
among
waria
in
Yogyakarta.
This
product
also
exfoliated
her
skin
but
was
not
as
strong
as
Placenta.
Partici-
pants
in
a
Yogyakarta
group
discussion
reported
Dr.
Jenong’s
krim
racikan
(concoction
cream)
to
be
quite
expensive;
most
could
not
afford
it.
Most
importantly,
such
products
have
to
be
used
continu-
ously.
Otherwise,
their
skins
will
revert
back
to
their
‘natural’
state.
Maintaining
one’s
bodily
transformation
is
thus
a
continual
process
rather
than
a
sequence
of
events
leading
to
a
fixed
and
permanent
outcome.
Covering
Covering
darker
skin
is
another
strategy
to
‘become
white’.
Here
we
found
foundation
and
loose
or
compact
powder
to
be
the
most
popular
options,
commonly
used
by
our
informants
when
they
could
no
longer
tolerate
the
adverse
effects
of
stronger
exfoliat-
ing
or
cream
products.
Whether
they
used
foundation
or
powder
depended
on
individual
preference,
the
occasion,
and/or
the
price.
One
advantage
of
covering
foundation
or
compact
powder
is
that
they
come
in
different
shades.
Kiki
from
Bulukumba
used
Kryolan,
a
heavy
foundation
to
cover
up
her
black
spots
and
applied
Double
Pixy,
a
compact
powder
containing
foundation
to
reduce
stickiness
and
absorb
makeup.
Sinta
from
Bulukumba
settled
with
a
covering
product
after
her
long
journey
using
exfoliating
and
cream
prod-
ucts
with
various
adverse
effects.
She
finally
decided
to
use
Kryolan
combined
with
Pixy
white
powder
for
her
‘full
makeup’
as
a
singer
and
beautician.
In
her
other
roles
as
college
student,
kindergarten
and
dancing
teacher,
she
only
uses
loose
baby
powder.
Imas,
a
beau-
tician
and
singer
from
Bulukumba,
claimed
that
she
accepts
her
dark
skin
and
prefers
to
keep
it
natural
(alami).
Nevertheless,
she
uses
Kryolan
on
her
face
‘to
cover
up’.
Although
our
informants
in
Yogyakarta
also
wanted
to
‘become
white’,
they
were
less
obsessed
with
this
than
their
counterparts
in
Makassar
and
Bulukumba.
They
explained
that
being
clean
(bersih)
and
light
(cerah)
were
more
important
than
being
white
(putih);
they
had
nevertheless
all
tried
products
to
lighten
or
at
least
cover
their
dark
skin.
We
explored
cultural
notions
of
beauty
in
our
Yogyakarta
focus
group.
Many
said
they
strove
for
putih-putih
Jawa
(Javanese
white)
skin,
which
is
not
‘too’
white.
They
also
repeatedly
used
the
term
hitam
manis
(black
sweet)
to
refer
to
the
beauty
of
darker
skin.
Uci
stated
that
she
does
not
want
her
skin
to
be
‘too
white’.
But
lighter
skin
was
nevertheless
important
to
attract
prospective
clients.
Indah
said
she
is
happy
with
her
relatively
dark
skin
because
she
thinks
it
is
exotic;
she
uses
a
mixture
of
powder
and
water
on
her
face,
hand
and
body
lotion
on
her
hands,
and
foundation
and
powder
on
her
legs
to
‘blur
her
masculine
body
and
dark
skin’.
Her
use
of
whitening
products
is
to
‘balance’
the
colour
of
her
face
and
other
parts
of
her
body
as
she
likes
to
wear
sexy
dresses
to
attract
clients.
Astri
reported
wearing
heavy
makeup
and
stockings
on
both
her
arms
and
legs
when
she
works
as
a
street
singer;
this
was
thought
to
be
more
alami
(natural)
–
beauty
being
an
internal
state
of
mind.
Yuli,
a
street
singer,
preferred
Pixy
white
powder
because
it
suits
her
‘Indonesian
skin
colour’.
While
she
believed
that
white
skin
is
valued
as
a
commodity
(nilai
jual),
she
said
she
can
‘balance’
her
brown
skin
with
her
personal
traits:
being
smart,
sexy,
a
tomboy,
and
easy
to
get
along
with.
Changing
and
mixing
skin-whitening
products
Our
informants
switched
between
techniques
and
brands
as
they
tried
to
find
those
that
best
‘fit’
their
individual
bodies.
Rara
from
Makassar
began
with
exfoliating
products
containing
Hydro-
quinone;
skin-reddening
led
her
to
try
SJ
day
and
night
creams
containing
Triethanolamine,
Methylparabon
and
Isoprophyl
Miris-
tate.
Though
the
SJ
creams
made
her
skin
itchy
(the
adverse
effect
of
Triethanolamine),
there
was
no
reddening.
Her
friends
sug-
gested
that
the
itchiness
was
a
sign
of
the
product’s
efficacy;
she
tolerates
the
itchiness
because
it
does
not
affect
her
outward
appearance.
Sinta
from
Bulukumba
tried
a
long
succession
of
prod-
ucts
that
worked
for
her
friends,
finding
each
to
have
undesirable
side-effects.
She
switched
from
exfoliating
products
to
creams
and
achieved
her
desired
result
with
the
SJ
brand.
But
when
she
stopped
using
it,
her
skin
turned
from
‘white’
to
‘yellow’.
Others
switched
products
when
they
could
no
longer
tolerate
the
adverse
effects.
Rara
from
Makassar
turned
to
creams
because
she
felt
that
her
exfoliating
product
(Maxi
Peel)
was
too
strong
and
smelled
like
alcohol.
Una
likewise
began
with
exfoliating
prod-
ucts
containing
Tretinoin
and
Hydroquinone.
While
RDL
initially
whitened
her
face,
her
skin
reddened
in
the
sun
and
then
broke
out
in
pimples.
She
tried
Diamond
cream
but
without
the
desired
effect.
She
subsequently
tried
Cusons
baby
powder
which
she
uses
during
the
day
when
she
works
as
a
beautician.
As
a
sex
worker
at
night,
she
uses
foundation
for
her
‘full
makeup’
(dandan)
which
makes
her
feel
beautiful
and
confident.
Mince
from
Makassar
finally
decided
to
cover
her
face
with
long-lasting
Pixy
white
powder
after
using
creams
that
made
her
skin
break
out
in
pimples.
Otti
from
Bulukumba
switched
from
Diamond
cream
to
Pixy
white
powder;
she
suspected
the
adverse
effects
she
experienced
with
Diamond
were
due
to
its
being
a
‘fake’
product.
Many
of
our
informants
combined
products.
Sari
from
Bulukumba
began
her
evening
ritual
with
Papaya
soap
to
cleanse
her
face,
then
applied
Maxi
Peel
to
remove
her
‘dead’
skin,
and
then
finally
UB
cream
to
soften
her
skin.
Her
morning
ritual
began
with
Papaya
soap
before
applying
Pixy
white
powder
for
her
daily

796
N.I.
Idrus,
T.D.
Hymans
/
International
Journal
of
Drug
Policy
25
(2014)
789–797
makeup.
Such
experimenting
was
very
common
among
our
infor-
mants
in
Makassar,
Bulukumba
and
Yogyakarta.
How
practices
spread
Alongside
the
influence
of
peers,
advertisements
played
an
important
role
in
the
consumption
of
skin-whitening
prod-
ucts.
Skin-whitening
is
a
well-established
practice
in
Indonesia,
evidenced
by
the
numerous
products
sold
in
market
stalls
and
advertised
on
TV,
the
internet
and
through
social
media
(used
by
our
informants
in
all
three
sites).
Our
informants
in
South
Sulawesi
used
similar
skin
whitening
products,
only
some
of
which
we
came
across
in
geographically
distant
Yogyakarta.
While
the
products
available
in
Yogyakarta’s
department
stores
differed
from
those
advertised
online,
our
informants
reported
that
they
were
influ-
enced
by
online
advertising.
There
was
variety
between
our
research
sites
in
the
favoured
means
to
enhance
breasts.
Practices
were
again
similar
in
our
two
research
sites
in
South
Sulawesi,
where
our
informants
favoured
the
use
of
hormones.
This
was
less
the
case
in
Yogyakarta,
where
our
informants
used
contraceptive
pills
but
rarely
turned
to
injec-
tions.
Some
of
our
informants
in
Yogyakarta
used
padded
bras;
others
aspired
to
have
silicone
breast
implants
and
mentioned
the
capital
city
of
Jakarta,
the
city
of
Surabaya
in
East
Java
or
abroad
(e.g.
Thailand)
as
the
best
places
to
go
for
such
treat-
ments.
Product
availability
differed
between
the
three
sites.
In
the
urban
centres
of
Makassar
and
Yogyakarta,
a
broad
range
of
contraceptive
and
skin-whitening
products
were
readily
avail-
able
in
pharmacies
and
stores.
Lili
from
Makassar
simply
asked
the
pharmacist
for
a
contraceptive
injection
and
received
it
without
any
questions.
This
was
confirmed
when
we
visited
a
pharmacy
in
Makassar.
When
we
pointed
out
that
the
pack-
age
states
‘by
medical
prescription
only’,
the
pharmacist
on
duty
explained
that
‘she
was
there’.
She
added
that
the
pharmacy
does
not
stock
a
lot
of
contraceptives
because
they
are
pro-
vided
free
of
charge
at
the
community
health
centre
(puskesmas).
In
contrast,
the
regency
of
Bulukumba
has
stricter
laws
on
the
sale
of
prescription
products,
which
places
a
premium
on
hav-
ing
the
right
personal
contacts.
Imas
from
Bulukumba
obtained
her
contraceptives
from
her
regular
retailer
in
the
market,
who
injected
her
as
well.
Susi
from
Bulukumba,
a
beauty
salon
owner,
received
injections
from
her
friend,
a
midwifery
student,
in
exchange
for
beauty
treatments.
Accessing
pills
was
more
com-
plicated
for
Manis.
Chemists
do
not
sell
them
to
‘men’
so
she
had
to
befriend
a
midwife
to
get
them
for
free.
Those
without
access
to
contraceptives
through
their
personal
networks
thus
relied
on
their
luckier
peers.
Our
informants
reported
that
skin-
whitening
products
can
easily
be
found
in
super/minimarkets,
while
‘fake’
products
are
commonly
sold
in
traditional
market
stalls.
Our
informants
generally
learnt
about
different
products,
dosages
and
techniques
through
word
of
mouth
(dari
mulut
ke
mulut),
foremost
from
their
waria
peers.
They
hardly
ever
con-
sulted
health
professionals
prior
to
using
hormonal
products.
Much
of
their
knowledge
thus
derived
from
self-experimentation
(cf.
Hardon
and
Idrus,
forthcoming;
Winter,
2009,2012).
Beyond
this,
there
was
one
significant
difference
between
our
research
sites
in
how
our
informants
learnt
about
products
and
techniques.
In
Makassar
and
Yogyakarta,
none
mentioned
healthcare
profession-
als
as
a
significant
source
of
information.
This
was
in
marked
contrast
to
Bulukumba,
where
information
on
the
use
of
contra-
ceptive
hormones
to
transform
bodies
came
from
a
midwife
(bidan)
employed
at
the
community
health
centre.
As
the
health
centre
only
caters
to
heterosexual
couples,
this
advice
was
given
unofficially
to
the
midwife’s
waria
friends
and
relatives.
The
midwife
advised
Susi
to
take
contraceptive
pills
to
grow
her
breasts
and
injections
to
reduce
her
musculature.
Also
in
Bulukumba,
Anti
stopped
using
hormonal
products
altogether
when
a
doctor
warned
her
about
the
long-term
effects.
Conclusion
This
article
has
examined
how
members
of
the
waria
commu-
nity
in
Indonesia
turn
to
hormonal
and
skin-whitening
products
to
transform
their
male
bodies
to
approximate
the
ideals
of
Indonesian
female
beauty
–
to
‘be
like
women’.
We
found
our
informants’
waria
self-image
to
be
deeply
rooted
in
and
consti-
tutive
of
their
physical
bodies.
That
is,
they
do
not
experience
their
bodies
as
fixed
biological
entities,
but
as
‘projects’
they
can
manipulate
with
pharmaceutical
products
and
cosmetics.
Breasts,
skin
and
muscle
mass
were
the
focus
of
their
body
management.
The
penis
was
a
lesser
priority;
buttocks
were
even
less
on
the
agenda.
Our
research
revealed
great
creativity
among
waria
in
exper-
imenting
with
chemicals
to
achieve
their
bodily
aims.
Their
practices
were
mostly
influenced
by
those
of
their
peers;
they
shared
information
and
products,
jointly
assessing
their
effects
and
competing
with
each
other
in
transforming
their
bodies.
To
lighten
their
skins,
they
experimented
(coba)
with
different
brands
of
exfo-
liating
liquid,
whitening
cream,
powder,
foundation,
face
soap
and
skin
scrub.
To
shape
their
bodies,
they
turned
to
different
brands
of
contraceptive
pills
and
injections,
switching
and
combining
prod-
ucts
and
changing
dosages
to
get
faster,
better
and
longer-lasting
results.
The
use
of
specific
products
and
brands
depended
on
their
compatibility
(cocok)
with
their
individual
bodies,
their
intended
and
additional
beneficial
and
adverse
effects,
and
whether
the
products
influenced
their
outward
appearance,
which
in
the
case
of
the
sex
workers
bore
directly
on
their
economic
prospects
(cf.
Irving,
2008).
Our
informants
had
to
continuously
balance
the
desired
and
adverse
effects
of
chemical
use.
Alarmingly,
bodily
pain
was
often
accepted
even
when
the
desired
results
were
minimal.
Pain
was
even
associated
with
product
efficacy;
when
an
exfoliating
liq-
uid
burnt
their
skin,
this
was
seen
as
a
sign
that
it
was
working.
Breast
pain
was
similarly
seen
as
a
sign
of
the
efficacy
of
hormones.
Side-effects
that
did
not
affect
outward
appearance
were
tolerated
more
readily
than
those
that
did.
In
Makassar
and
Bulukumba,
the
attitude
to
whitening
was
captured
in
the
phrase
biar
menderita
yang
penting
putih
(as
long
as
it
becomes
white,
suffering
is
insignificant).
Physical
pain
is
an
accepted
part
of
bodily
transfor-
mation.
The
products
used
by
our
informants
generally
did
not
provide
permanent
solutions.
Stopping
with
their
particular
regime
of
chemical
use
meant
that
their
bodies
reverted
to
where
they
started.
When
this
happened,
they
suffered
psychologically.
Bodily
transformation
is
thus
an
on-going
process
that
requires
contin-
uous
work;
it
is
never
complete,
nor
can
it
ever
be
stopped.
Over
time,
some
of
our
informants
returned
to
‘being
natural’,
turning
to
padded
bras
rather
than
chemicals
when
the
pain
or
side-effects
become
intolerable.
Others
dreamt
of
silicone
injections
which
they
saw
as
a
more
permanent
solution.
We
observed
that
waria
in
Yogyakarta
were
less
obsessed
with
both
contraceptives
and
inva-
sive
whitening
products,
often
mentioning
the
ideal
of
skin
that
is
hitam
manis
(sweet
black).
Our
findings
have
implications
for
harm
reduction
programs.
The
risks
here
do
not
concern
HIV
transmission
(although
hor-
mones
are
injected,
needles
are
not
shared).
Our
point
is
that
the
focus
of
many
harm
reduction
programs
on
narcotics,
needle-
sharing
and
sexually
transmitted
infections
has
neglected
those

N.I.
Idrus,
T.D.
Hymans
/
International
Journal
of
Drug
Policy
25
(2014)
789–797
797
chemicals
that
are
not
narcotics,
not
related
to
sexually
transmitted
infections,
and
are
legally
and
freely
available
–
though
they
equally
affect
the
lives
and
health
of
those
who
use
them.
The
risks
to
health
that
we
encountered
concerned
unsafe
skin-whitening
products
(Hydroquinone
can
cause
cancer)
and
the
long-term
side-effects
of
hormones
in
high
dosages.
While
our
informants
were
concerned
about
these
risks
and
tried
to
manage
them
through
their
own
per-
sonalized
regimes
of
chemical
use,
they
would
benefit
from
more
information
on
the
substances
that
evidently
play
such
a
central
role
in
their
lives.
Such
information
should
not
only
deal
with
the
substances,
but
how
they
are
used.
Contraceptive
hormones
are
fairly
safe
products
and
hence
available
over
the
counter
in
pharma-
cies.
The
safety
issues
arise
when
the
products
are
used
off-label
in
large
quantities.
The
side-effects
of
hormonal
drugs
used
by
male-
to-female
transgenders
have
been
described
in
a
growing
body
of
studies
conducted
in
formal
gender
care
settings
which
have
associated
cross-sex
hormone
therapies
with
increased
rates
of
cardiovascular
disorders,
osteoporosis,
and
cancers
(Van
Kesteren,
Asscheman,
Megens,
&
Gooren,
1997;
Wierckx
et
al.,
2012)
as
well
as
psychological
problems
leading
to
major
depression
(Nuttbrock
et
al.,
2012).
Our
findings
on
skin-whitening
practices
suggest
that
drug
policy-makers
are
not
paying
sufficient
attention
to
the
safety
of
cosmetics.
Though
products
containing
Hydroquinone
are
officially
only
available
in
Indonesia
with
medical
prescriptions,
we
found
them
to
be
freely
available.
Harm
reduction
programs
which
more
broadly
address
chemical
harm
need
to
be
attuned
to
the
local
specificities
of
chemical
use.
Finally,
our
study
revealed
our
informants
to
be
concerned
about
long-term
risks
to
health;
many
did
do
not
expect
to
live
long.
The
variety
of
strategies
found
in
our
study
to
bridge
the
mismatch
between
male
bodies
and
female
‘souls’
can
be
discussed
in
relation
to
their
relative
safety
for
long-term
health,
enabling
waria
to
live
longer
and
healthier
lives.
Acknowledgements
We
are
grateful
to
our
waria
interlocutors
who
shared
their
life
stories
with
us,
and
to
the
field
researchers
who
helped
conduct
the
initial
grand
tour
ethnographies
in
Yogyakarta
and
South
Sulawesi.
Amelia
Damayanti
Ihsan
contributed
to
the
fieldwork
and
NVivo
analysis.
We
thank
Anita
Hardon
and
the
anonymous
peer
review-
ers
for
their
suggestions
to
improve
the
manuscript,
and
Martine
de
Rooij
who
did
so
much
to
make
this
special
issue
possible.
The
Chemical
Youth
project,
of
which
this
research
is
a
part,
is
funded
by
the
European
Research
Council
(ERC-2012-AdvG-323646).
Conflict
of
interest
None
declared.
References
AIA.
(2012).
ISO
(Informasi
Spesialite
Obat)
Indonesia.
Jakarta:
PT.
Isfi.
Ashikari,
M.
(2005).
Cultivating
Japanese
whiteness,
the
‘whitening’
cosmetics
boom
and
the
Japanese
identity.
Journal
of
Material
Culture,
10,
73–91.
Besnier,
N.,
&
Alexeyeff,
K.
(2013).
Gender
on
the
edge:
Transgender,
gay
and
other
Pacific
Islanders.
Honolulu:
University
of
Hawai’i
Press.
Blackwood,
E.
(2005).
Transnational
sexualities
in
one
place:
Indonesian
readings.
Gender
&
Society,
19(2),
221–242.
Blackwood,
E.
(1998).
Tombois
in
West
Sumatra:
Constructing
masculinity
and
erotic
desire.
Cultural
Anthropology,
13(4),
491–521.
Boellstorff,
T.
(2008).
Playing
back
the
nation:
Waria,
Indonesian
transvestites.
Cul-
tural
Anthropology,
19(2),
159–195.
Boellstorff,
T.
(2007).
A
coincidence
of
desires:
Anthropology,
queer
studies,
Indonesia.
Durham
and
London:
Duke
University
Press.
Boellstorff,
T.
(2005).
The
Gay
Archipelago:
Sexuality
and
nation
in
Indonesia.
Prince-
ton:
Princeton
University
Press.
Graham-Davies,
S.
(2010).
Gender
diversity
in
Indonesia:
Sexuality.
In
Islam
and
Queer
Selves.
London:
Routledge.
Hardon,
A.,
&
Idrus,
N.
I.
(2014).
On
coba
and
cocok:
Youth-led
drug-experimentation
in
Eastern
Indonesia.
Forthcoming
in
Anthropology
and
Medicine.
Idrus,
N.
I.,
&
Hardon,
A.
(2014).
Chemicals,
biocapital
and
the
every-day
lives
of
sex
workers
and
waitresses
in
South
Sulawesi.
In
L.
R.
Bennet,
&
S.
Graham-
Davies
(Eds.),
Sexing
Indonesia:
Sexual
subjectivities,
politics
and
sub-cultures
of
the
Reformasi
Era.
London:
Routledge,
submitted
for
publication.
Irving,
D.
(2008).
Normalized
transgressions:
Legitimizing
the
transsexual
body
as
productive.
Radical
History
Review,
100,
38–60.
Johnson,
M.
(1997).
Beauty
and
power:
Transgendering
and
cultural
transformation
in
the
Southern
Philippines.
Oxford:
Berg.
Koon,
T.
Y.
(2002).
The
Mak
Nyahs:
Malaysian
male
to
female
transsexuals.
Singapore:
Eastern
University
Press.
Kosenko,
K.
A.
(2011).
Contextual
influences
on
sexual
risk-taking
in
the
transgender
community.
Journal
of
Sex
Research,
48(2–3),
285–296.
Kulick,
D.
(1998).
Travesti:
Sex.
In
Gender
and
culture
among
Brazilian
transgendered
prostitutes.
Chicago:
University
of
Chicago
Press.
Nanda,
S.
(1990).
Neither
man
nor
woman:
The
Hijras
of
India.
Belmont:
Wadsworth.
Nanda,
S.
(2000).
Gender
diversity:
Cross
cultural
variations.
Waveland:
Waveland
Press.
Nuttbrock,
L.,
Bockting,
W.,
Rosenblum,
A.,
Mason,
M.,
Macri,
M.,
&
Becker,
J.
(2012).
Gender
identity
conflict/affirmation
and
major
depression
across
the
life
course
of
transgender
women.
International
Journal
of
Transgenderism,
13(3),
91–103.
Sanabria,
E.
(2013).
Hormones
et
reconfiguration
des
identités
sexuelles
au
Brésil.
Clio:
Femmes,
Genre.
Histoire,
37,
85–104.
Sinnott,
M.
J.
(2004).
Toms
and
Dees:
Transgender
identity
and
female
same-sex
rela-
tionships
in
Thailand.
Honolulu:
University
of
Hawai’i
Press.
Suja,
S.,
Sutanyawatchai,
S.,
&
Siri,
S.
(2005).
Quality
of
life
in
male
to
female
trans-
sexuals
using
and
not
using
female
hormone
therapies.
Chiang
Mai:
Chiang
Mai
University.
Van
Kesteren,
P.
J.
M.,
Asscheman,
H.,
Megens,
J.
A.
J.,
&
Gooren,
L.
J.
G.
(1997).
Mor-
tality
and
morbidity
in
transsexual
subjects
treated
with
cross-sex
hormones.
Clinical
Endocrinology,
47(3),
337–343.
Wierckx,
K.,
Mueller,
S.,
Weyer,
S.,
Van
Caenegem,
E.,
Roef,
G.,
Heylens,
G.,
et
al.
(2012).
Long-term
evaluation
of
cross-sex
hormone
treatment
in
transsexual
persons.
Journal
of
Sexual
Medicine,
9(10),
2641–2651.
Wieringa,
S.
E.
(2012).
Passionate
aesthetics
and
symbolic
subversion:
Heteronor-
mativity
in
India
and
Indonesia.
Asian
Studies
Review,
36(4),
515–531.
Wieringa,
S.
E.
(1999).
Desiring
bodies
or
defiant
cultures:
Butch-femme
lesbians
in
Jakarta
and
Lima.
In
E.
Blackwood,
&
S.
E.
Wieringa
(Eds.),
Female
desires:
Same-sex
relations
and
transgender
practices
across
cultures.
New
York:
Columbia
University
Press.
Winter,
S.
(2009).
Cultural
considerations
for
the
world
professional
association
for
transgender
health
standards
of
care:
The
Asian
perspective.
International
Journal
of
Transgenderism,
11(1),
19–41.
Winter,
S.
(2012).
Lost
in
transition:
Transgender
people.
In
Rights
and
HV
vulnera-
bility
in
the
Asia-Pacific
region.
Thailand:
UNDP.