It's been roughly 10 years since transwoman Kittanut Na Chiangmai underwent sex reassignment surgery, and life only got better after that, she said. The 35-year-old serves as council member for her local Sub-District Administrative Organisation in Sikhiu, Nakorn Ratchasima. She's in a long-term relationship with her partner, and her parents, community and workplace are accepting of who she is.
"I was actually nervous that I wouldn't wake up normal [post-surgery]," Kittanut said. She dreamt of becoming a woman from a young age.
As part of the transitioning process, Kittanut received hormone replacement therapy for a year -- as well as a few psychological checks -- prior to getting the surgery. She spent a total of 10 days at the clinic for two operations -- sex change and breast implants -- which she decided to undergo simultaneously.
A decade ago, information was not readily available. Kittanut relied mostly on conversing with the "sisters" who've previously gone under the knife before deciding on a certain clinic in Pratunam.
Transman Kanattsanan Dokput, 31, co-founder of ftmbangkok.com -- a website for transmen -- is comparatively more informative than Kittanut was a decade ago. He has been actively seeking advice from various medical professionals, and will soon undergo a sex change operation at an undisclosed hospital. "I feel that the doctor's skill matters the most, and it has to be experts only," said Kanattsanan. "You also have to be ready to pay as this surgery will stay with you for life."
Kittanut and Kanattsanan are just a few among the crowd who seek to correct what nature has failed to give them: a body that is right for their true gender identity. There are thousands of transgenders -- both transwomen (male to female) and transmen (female to male), Thai and foreign -- who undergo sex reassignment operations yearly in Thailand.
Kittanut Na Chiangmai, a transwoman.
"The medical journey for sex change operations in our country was only jump-started around 30 years ago. But we're now at the forefront of this industry," said Dr Sukit Worathamrong, a plastic surgeon at Yanhee Hospital and a board member of the Society of Plastic and Reconstructive Surgeons of Thailand.
Gender dysphoria -- a condition in which one identifies with a gender opposite to his or her biological sex -- has seen a traumatic and bloody history. There were numerous cases, around the world, where transsexuality was viewed as a mental illness. Drugs, electric shocks and other forms of violence have been used to try "converting" transgenders back to "normal", but to no avail. Hence, the sex change operation was conceived.
"You can't just convert one's gender identity to fit its biological sex. So, it's preferable to alter the body instead," said Dr Greechart Pornsinsirirak, a plastic surgeon at Yanhee Hospital who specialises in Male-to-Female (MtF) sex change surgery.
In the Western world, the medical procedure to aid gender transition has been progressing since the early 1900s. The recent movie The Danish Girl is a good reference. The film (currently in cinemas) depicts the life of transwoman Lili Elbe -- one of the first-known recipients of sex reassignment surgery.
Elbe was a pioneer case in the pursuit of femininity by altering her physical form through surgical procedures which, at that time, was at the experimental stage. According to historical accounts, Elbe died after complications from her fifth bout of surgery.
Fortunately for transgenders of latter generations, technology has come a long way from Elbe's experimental days. The medical knowledge, standards and regulations have advanced markedly. Thailand, especially, is known as a paradise for sex change surgery for our lower costs, skilled doctors and, admittedly, more relaxed legal conditions.
It should be noted that the current technology for Female-to-Male (FtM) surgery is not as advanced as that of MtF.
Kanattsanan Dokput, a transman.
"On a scale of one to 10 in terms of form and function, I would give MtF a 10, and FtM an 8.5," said Dr Sukit, who specialises in FtM sex change surgery. "It's easier to remove an excess part rather than to build something out of nothing."
There are now various medical facilities -- big and small -- fast mushrooming in cities like Bangkok, Chiang Mai, Chon Buri, Phuket and Hat Yai that offer sex change operations.
Aside from major hospitals, some people also seek surgical procedures at smaller clinics for cheaper options.
Based on internet reviews, Life visited a clinic in Bangkok that is popular for cosmetic surgeries -- from nose jobs to MtF sex changes -- to see how it operates.
The clinic is next to a beauty salon, with only its name plastered out front on a plain-looking facade. Inside, there is a picture of a doctor with his full name and medical licence number. The clinic is manned by one surgeon. When asked if sex change is his specialisation, the receptionist replied that the doctor used to work at a hospital famous for sex change surgery.
How credible are these places? Dr Sukit said that before a medical facility could offer services to the public, it has to be certified and evaluated by the Bureau of Sanatorium and Art of Healing to make sure the place is up to standard.
"They all have to pass a checklist. So, if you see a clinic up and running, that's a guarantee -- to a certain extent -- that the place has passed set criteria and standards to offer safe medical services," added Dr Sukit.
To compare pricing, MtF surgery via skin graft technique at the above clinic costs 100,000 baht, but 125,000 baht at Yanhee Hospital. A colon graft -- another method offered at Yanhee Hospital -- costs around 180,000 baht due to a more complicated process. FtM at Yanhee Hospital costs 400,000 to 500,000 baht given the procedure is way more complicated.
The sex reassignment surgery happening worldwide mostly adheres to an international standard of care set by the World Professional Association for Transgender Health (WPATH) -- an organisation devoted to treating gender dysphoria -- to make sure the procedure can help transgenders with the safest and latest methods available for their complete transition.
Aside from adhering to WPATH's standard of care, the Medical Council of Thailand also released "Rules for Treatment in Sex Change Operations" in 2009 as part of its medical profession's ethical regulations. As per Thai law, sex change surgery is allowed for those above the age of 18. However, those below the age of 20 need parental consent to go ahead with the procedure. Medical professionals who perform the surgery have to be certified surgeons specialised in this field.
Evaluation by two psychologists is also needed to determine if the patients are suitable recipients of sex reassignment surgery. This means they need to try living in a gender they choose for at least a year to see if this is the kind of lifestyle they want, as well as to see how accepting their society is. The purpose is to minimise mental and social complications patients could experience after such an irreversible process, explained Dr Greechart.
"There are people who want the surgery, but haven't even dressed up in gender-specific clothes nor have come out to society, yet. We can't perform surgeries in such cases. These surgeries are irreversible, so they have to be very sure of themselves. They have to feel it since birth that this is not the body they can identify with," said Dr Greechart. More than 70% of people seeking sex change surgery at Yanhee Hospital are foreigners. In a year, Dr Greechart said he's responsible for more than 100 cases.
"Before you do anything with your body, you have to do thorough research on both the procedures and possible side effects. This information can be sought from related organisations or from the Medical Council. It's even better if you can discuss personally with doctors before making a decision," advised Dr Sukit. Googling for online reviews is never enough. Post-surgical care is another crucial matter. Hygiene of the newly constructed organs needs to be taken seriously. For transwomen, their new vagina will be subjected to constant dilation especially in the first year of surgery to maintain desired girth and depth. Transmen should also use their new penises with care.
Hormone replacement therapy will become a lifetime requirement for most to maintain healthy functioning of the body. This needs to be under careful monitoring, and the dosage needs to be adjusted as the patients grow older. Each transgender has to accept the fact that should they decide to opt for a sex change they will most likely be under constant professional care for life.
Kanattsanan is well informed of the unavoidable. And he's ready despite whatever hardship he'll face in the future.
"I already look and live like a man. So, I hope this surgery will make it easier as I go about my daily life," he said.
