The correct answer is: Environmental problems
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Answer: Gender-affirming surgery.
Explanation: Gender-affirming surgery is the surgery that is done to reassign the gender to any individual who is facing the dispute between the inner gender feeling and the outer body.This surgery is also known as transgender surgery.
It is usually done for the clarification of the people with gender they have from the time of birth and the true gender they identify for theirselves.
Ramesh is also undergoing the gender- affirming surgery because he truly believes of having transgender identity and was born as a male child. Surgery is done regarding the change of genitals he gained during his birth
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