In 2004, it was reported that Lahore alone has 10,000 active transvestites.
People have started accepting acts of Sex reassignment surgery to change their sex as a norm either compelled by Gender dysphoria. There are situations where such cases have come into the limelight. A 2008 ruling at Pakistan's Lahore High Court gave permission to Naureen, 28, to have a sex change operation, although the decision was applicable only towards people suffering from gender dysphoria.
On the 18th of June in 2016 a small clerical body in Lahore know as Tanzeem Ittehad-I-Ummat declared Transgender marriages legal under Islamic law. These clerics are affiliated to the Pakistan-based organization issued a Fatwa on Pakistani transgender people where a trans woman (born male) with "visible signs of being a woman" is allowed to marry a man, and a trans man (born female) with "visible signs of being a man" is allowed to marry a woman. Pakistani transsexuals can also change their gender. Muslim ritual funerals also apply. Depriving transgender people of their inheritance, humiliating, insulting or teasing them were also declared Haraam. Although there are no Fatāwās by a Mufti for it or against the ("Zenanas") or Eunuchs and Hermaphrodites within the country, that remains a debatable issue for the existing various sexual minority diverse communities within Pakistan respectively.
On the 5th of February in 2018, a Senate committee determined that transgender people could inherit property without being required to have their gender decided by a medical board. Some hijras in Pakistan use hormones and silicone to bring focus on their feminine characteristics; however, this is usually done in terrible medical conditions without proper equipment and supervision, as expensive Sex change surgeries in Pakistan are not done mostly due to lack of education on the topic and the taboos of society.
Even though the Pakistani Government recognizes a third gender on ID cards, many people from the LGBT community are hesitant to apply for it as they will not be allowed to enter the holy city of Mecca in Saudi Arabia as a transgender person.
Despite the British Raj imposition, Pakistan was still a very much an open society. Gay Pakistanis have had a much better experience in Pakistan than they did in London or elsewhere. But, all of that changed in the 1980s, under the sixth President of Pakistan, His government took the law to lifetime imprisonment, and even death in certain areas under Sharia law. More and more Wahhabi-style religious schools or madrasas were opened in the country, generally with money from the Middle East as well as teachers educated in that region.
However, 147 years after the British had brought Sodomy Laws to the entire region under their collective domain, the British Broadcasting Corporation (BBC) has noted in 2005 that gay life in Pakistan is still “less inhibited than in the west.” This is because the culture is much stronger than laws imposed by foreign powers and greedy local politicians. There have been a lot of changes, sometimes they are good and sometimes bad, but changes are constant companion to gay Pakistani life in the country. At the moment, one of the mysteries is that people deny the history of gay life in Pakistan. While in Pakistan speaking to the National Public Radio, Pakistani-American scholar Taymiya R. Zaman, who happens to be an expert in Islamic History, said that “You can’t look at something that already existed – and there is a shrine devoted to it – and now say it was unacceptable.” In March 2012 at the Human Rights Council, Hina Jilani, who was then also Chair of the Human Rights Commission of Pakistan and former Special Representative of the Secretary-General said, "it was very important to emphasize that a serious obstacle was the persistent denial of protection for people from violence on the basis of sexual orientation and gender identity. That denial and rejection was not prudent for any Government that claimed commitment to the promotion and protection of human rights. It was not convincing when culture and religion were used as a shield and an excuse for failure to protect. There was no notion of responsibility that allowed duty bearers to selectively hold out on protection."
A number of the more liberal, secular parties in Pakistan tend to agree in principle to granting rights to various LGBT communities in the country, but are afraid to act too openly or quickly due to fear of extremist religious groups such as the Taliban who are against any such rights.
Time and again, various such parties and leaders have said that Pakistan needs to be more open, in public, about sexual orientation and gender identity issues. Yet, the sense persists that no public organization, club, or society would be allowed to endorse (or officially support) LGBT human rights, or even act as a social network for LGBT people, in the Islamic State. Only the "Pakistan Greens" has publicly expressed support for their LGBT rights for its citizens in general and abroad (Overseas Pakistanis) and has called for greater public openness and awareness about Sexual orientations and gender identity issues.
Only now, recently, on the 23rd of September in 2012, the Supreme Court of Pakistan has acted in a very bold manner and defied the religious right, by granting for the first time, three basic rights to transsexuals i.e.
(a) the right to be recognised as a 'Third sex or gender'
(b) the right to vote as Pakistani citizens as transsexuals and
(c) granted the fixation of job quotas in the public/government sector, for transsexual people.
These are all landmark decisions by the apex court and hopefully the situation for LGBT rights will improve more in future. The 'Third gender' was officially protected from discrimination by the Supreme Court of Pakistan in 2010. Surprisingly, 60% of Pakistanis would have no concerns about having a gay or lesbian neighbour, and 32% of Pakistani people support gay marriage.
Pakistani media strictly censors LGBT related news stories. In late 2013, the Government of Pakistan censored the website Queerpk.com from being viewed.
On the 9th of January in 2017, the Lahore High Court ordered the Government to include transgender people in the national census.
On the 19th of December in 2017, a Senate committee approved the Transgender Person (Protection of Rights) Bill 2017, which would give transgender people full legal protection. It also provides for a clear definition of transgender and provides them relief in case of need of medical and other facilities. The Pakistani Senate debated the bill's final approval and was approved on the 7th of March in 2018, after which the bill was sent to the National Assembly of PAKISTAN, with immediate effect thereof respectively.
Under the Transgender Person (Protection of Rights) Act 2018, Pakistanis may choose to self-identify as male, female, or both. They may express their gender according to their own preferences, and they may have their gender identity of choice reflected on their documents, "including National Identification Cards, passports, driver's licenses and education certificates."
The Act defines "transgender person" as someone with a "mixture of male and female genital features or congenital ambiguities," a male who "undergoes genital excision or castration," or, more broadly, "any person whose gender identity and/or gender expression differs from the social norms and cultural expectations based on the sex they were assigned at the time of their birth," which allows people to self-identify as such. They are guaranteed the right to inherit assets and to run for public office.