Sex Reassignment Surgery in Thailand (male to female) – a quick guide

MONTAGE: People Magazine

Thailand has a well-deserved reputation for excellence in sex reassignment surgery and the before and after care of patients. The country has a long relationship with Kathoeys, affectionately referred to in Thailand as ‘ladyboys’, and consequently, a well-developed approach to quality surgery in this area. The following article has been prepared by My Medi Travel.

Kathoey or katoey is a male-to-female transgender person or person of a third gender, or could be an effeminate homosexual male. Transgender women in Thailand mostly use terms other than kathoey when referring to themselves, such as phuying (Thai: ผู้หญิง ‘woman’). A significant number of Thais perceive kathoey as belonging to a third sex, including some transgender women themselves.

For people who want to match their born gender with what they feel is their ‘true’ gender, Thailand has an excellent reputation for Sex Reassignment Surgery (SRS) – also known as Gender Reassignment Surgery, Sex Change Operation, and MtF Surgery, to name a few. In this article we focus on the male to female related surgeries.

So, what makes Thailand such an attractive destination for this type of procedure? In short, it’s because patients can get the most out of such surgeries in Thailand thanks to the number of highly trained surgeons, low-cost and quality health care, and decades of knowledge and experience in perfecting this procedure.

If you’re considering SRS in Thailand, or you have a family member, a partner, or a friend who is wondering what is involved in the procedure, this guide should help to paint a clearer picture.

The Procedures

To undergo SRS is a huge, life-changing decision that should not be made lightly. It is a lengthy process that requires a lot of resilience and patience. Before the actual surgery, you will first need to live as a woman for at least a year and undertake hormone treatment to help reshape your body contour and stimulate the growth of a labia majora.

Here’s a list of the required prerequisites that all surgeons will insist upon before considering your case:

• You must be at least 20 years old or have consent from parents / legal guardians for those between 18 and 20.
• At least 12 months of successful and continuous real-life experience living as a woman.
• At least 12 months of continuous hormonal therapy.
• Must consult with a psychiatrist in your country and in the country where the procedure will be performed (this can be arranged in your chosen hospital).
• Physically fit for surgery.

The actual process usually involves a few procedures:

• Orchiectomy (removal of testes) and Penectomy (removal of the penis)
• Vaginoplasty (creation of a vagina)
• Breast Augmentation
• Facial and Voice Feminisation Surgery (FFS and VFS)

You may also choose other surgical procedures, such as a Tracheal Shave to remove your Adam’s apple, or a Buttock Augmentation to increase the volume of the buttocks. Since every patient is unique, the procedures involved in SRS can be performed based on your needs and budget.

The most important part of male-to-female surgery is the creation of the vagina. There are numerous surgical techniques to do this based on your preference. You can discuss with your surgeon which one is best for you. The other popular techniques are as follows:

1. SRS without vaginal depth

• This procedure is suitable for who those do not need vaginal penetration of sexual intercourse and unwanted vaginal dilation.
• Hospitalization: 4 nights
• Duration time of surgery: 2.5 hours
• Recovery time in Thailand: 3-4 weeks
• Approx. cost $8,400 USD

2. SRS with Penile Skin Inversion

• Suitable for patients who do not want a vagina for sexual intercourse, particularly popular with elderly trans people. Depth is around 2-4 cm (1-2 in) and penile hair removal is required prior to surgery.
• Surgery: 2.5 hours
• Hospitalization: 4 nights
• Recovery time in the local area is 3-4 weeks
• Approx. cost $9,800 USD

3. SRS with Scrotal Skin Graft

• Scrotal skin is used to create a vaginal depth of up to 13-15 cm (5-6 in), depending on skin quality and quantity (additional depth is possible by using groin skin). This is the most popular SRS procedure.
• Surgery: 4 hours
• Hospitalization: 6 nights
• Recovery time in the local area is 3-4 weeks
• Approx. cost $9,800 USD (with the option to increase depth further for $1,400 USD)

4. SRS with Sigmoid Colon by Laparoscopic Technique

• The Sigmoid colon is used to create the vagina, allowing for greater depth than what is possible with SRS with a scrotal skin graft. More suited to those with less scrotal skin or those who prefer to have a lubricated vagina, like that of a biological woman. By far the most expensive technique.
• Surgery: 6 hours
• Hospitalisation: 7 nights
• Recovery time in the local area is 3-4 weeks
• The open technique, with a ~8-10 cm incision scar in the bikini line; approx. 13,700 USD
• Laparoscopic technique; 4 small incisions in the abdomen; approx. 18,850 USD

Caitlyn Jenner, possibly the most famous, and well-publicised, transgender person

Recovery

Recovery after surgery will be a long and painful process. It will also require several follow up procedures as well as constant monitoring so you will have to stay a little bit longer at the hospital until you are fully ready to be discharged. Generally, allow for a minimum of 3 weeks stay in Thailand or the country of your choice area after your surgery. Most people are able to return to work in about 4-6 weeks after a sex change operation. Furthermore, you can resume strenuous work and exercise in about 6-8 weeks. It is vital that you strictly follow all medication instructions during your recovery period.

Aftercare

Social support is very important before and after the surgery, especially the support that comes from your family and loved ones. You have to be socially and emotionally stable before you undergo the operation. This is why it is required that you have proper counseling to help you with your emotional wellbeing. You have to prepare yourself mentally, before, during and after transition because it can be quite overwhelming and stressful.

It is also important that you maintain regular check-ups with your local Doctor to monitor the progress of your healing and avoid such complications.

Success Rate

The success rate for a sex change is very high, given our technological advancements. Gender reassignment surgery from male to female has a higher success rate than female to male; this is why more male transgender opts for a sex change.

However, given the nature and complexities of this type of surgery, you also have to be aware of its complications:

• Possible risk of infection
• Severe pain
• Bleeding
• Blood clotting and scarring

Possible side effects may also include:

• Decreased sexual sensation and ability to orgasm
• Fistula (opening between rectum and vagina)
• Narrowing of vagina and hair growth in the vagina from the grafted tissue
• Partial death of tissue used to create the new vagina

Costs

SRS can be very expensive, especially since it is difficult to get this type of surgery in many countries. One reason why Thailand is popular with those who want to change their sexual identity is that the country offers more affordable fees. Many patients come from the United States because the US has the most expensive male-to-female SRS prices in the world.

The prices range from $25,000 to $30,000 for just the reconstruction of the genitals alone. If you want to add breast augmentation and voice feminisation surgery, you can expect to pay more than $50,000. Additionally, some clinics in the US don’t include consultation fees in their prices, so you need to pay at least $50-100 for every consultation.

In general, SRS in Thailand costs around a third to half of what it can cost in the United States. For the reconstruction of the genitals in Thailand, you can expect to pay between $8,400 to $13,700 depending on which technique you choose.

Breast augmentation costs approximately $4,100 to $6,170 and Voice Feminisation Surgery costs between $3,590 to $7,180. In total, you will need to pay around $16,090 to $27,050 in Thailand for the complete procedure. These prices can also include packages, such as hospitalization accommodation, post-operative care, consultation fee, post-operative care, medications, and transportation.

Quality

The low-cost healthcare in Thailand does not mean low-quality treatment. In fact, Thailand is extremely popular among medical tourists because the country is known to have high-quality healthcare. Numerous medical centers in Thailand are accredited by prestigious international organizations, such as the Joint Commission International (JCI). The country has come a long way since its first Sex Reassignment Surgery in 1975, with many surgeons specialising in SRS for years, some even have over 20 years of experience. With their skills and experience, the surgeons and clinics can give patients the proper care they need and guarantee the best possible result.

Since there are many medical centres in the country that offer Male to Female SRS, it is understandable that some will better than others. To avoid disappointment, do your research, read reviews, find out about the clinic’s accreditation, and ask for your surgeon’s certifications. Better still, seek out the services of a dedicated Medical Tourism Facilitator like MyMediTravel who will guide you through the whole process and find you the best possible surgeon/clinic/hospital available and within your budget.