This is an excerpt from an upcoming memoir of my trip to Thailand to have SRS surgery, the last step in my personal transition journey.
The Sex Change Capital of the World
Thailand has become the sex change capital of the world for a couple of reasons. Both are important to my decision to go to Bangkok for my SRS.
Thailand has a booming medical tourism industry. It has first rate health care. Most of the hospitals in Bangkok are certified to the international standards of Western Europe. They are as good, or better, than most U.S. Hospitals. But at the same time, Thailand still has a developing country’s economy. The exchange rate when I went in 2010 was thirty baht to one U.S. dollar. To put that into perspective, my hotel was less than thirty U.S. dollars a night and a decent meal from a street vendor could be had for twenty baht (less than a dollar U.S.).
Medical care is cheaper there, even adjusting for exchange rates. Thailand has socialize medicine for its citizens and the cost is reasonable. I did some digging while I was there and discovered some telling facts. The cost of a heart valve replacement in the U.S. in 2010 was in the neighborhood of 160,000 dollars. If your insurance covered 80% of that, that was still 32,000 out of pocket. The cost of the same procedure in Thailand was 10,000 U. S. dollars. No wonder so many Americans went to Thailand for surgery.
The less practical, but more important reason Thailand is the “Sex Change Capitol of The World” has to do with Thai culture. Buddhist societies tend to be more accepting and open than those cultures dominated by dogmatic faiths. Most Eastern societies make some sort of space, no matter how small, for gender variant people. Thailand, however, puts the others to shame in this category.
I discovered, while reading the Teachings of Buddha that was left in my hotel room, that the Buddha claimed there were no less than four sexes. In addition to male and female, there were intersex (hermaphrodites) and another category that can only be translated as “gender variant.” This last category was made up of people who looked like one sex but acted like the other. Their condition, according to the Buddha, was karmic.
In rural areas this was interpreted to mean that it was a punishment for some past life misdeed. There they may be subjected to much of the same bias and discrimination as in the west. But in more enlightened area, and larger cities, “karma” is typically interpreted to mean they were simply born that way.
In the Bangkok nightlife they are called Kathoey or Ladyboys. In more respectable circles they are called Sao Praphet Song or literally “another kind of woman.” They are a staple in Bangkok and mostly live in peace. For those seeking medical transition, the local Sao Praphet Song and the western trans woman form a symbiotic union. The Sao Praphet Song make a ready market for plastic surgeons willing to perform SRS surgery, giving them a chance to hone their techniques. The western transgender tourist make the surgery a lucrative enterprise for good surgeons.
But why did I go to Thailand?
I got this question a lot before leaving. In fact I think I got the ’why Thailand? ’ question more than the ‘why have a sex change?’ I had three answers. There was the cost. There was the doctor. And there was the real reason.
SRS is not a cheap surgery to have. It’s also not covered by insurance. There are three well known and reliable surgeons in the United States that perform the standard SRS surgery, known as vaginoplasty. Of the three my favorite was Christinne McGinn. I had met her in person twice and seen her results online. Her fee was $23,000. She also expected that her patients would stay in the region for at least three weeks to a month for follow up care.
Meanwhile, surgeons in Thailand ran anywhere from five to fifteen thousand US Dollars. It wasn’t just the cost of surgery that tipped me however, it was the cost of staying. A hotel in Pennsylvania where McGinn practiced could easily run a hundred dollars or more a night. The thirty day hotel bill not counting food and travel expenses would add up quickly.
It is expensive to fly to Thailand. My two tickets (I paid for my travel companion, Kelly) ran about $2,400. But that and my medical bill were the lions share of what I paid.
This was the practical reason that I repeated to many friends and co-workers. It made sense. If you did the math you could save a small fortune by traveling.
Cost didn’t convince my close friends, or my family. They were more concerned about my health. I had an answer for them, too. Like most trans people I hadn’t just thought of doing this recently. I had spent years doing online research. I knew who was who, and I choose a doctor who belonged in the who’s who when it came to trans stuff. In fact, most trans people ranked him one of the best in the world.
Vaginoplasty is one of those surgeries where the skill of the operating team is tantamount. Like many plastic surgeries, it’s the skill of the surgeon that determines the end result. However in vaginoplasty it’s more than that.
The most dreaded complication is a vagino-rectal fistula. It occurs infrequently; once in four hundred surgeries is the worst figure I have seen. It happens most often when the doctor accidentally nicks the bowels while trying to create room for the new vagina. Dr. McGinn refers to the process of creating the opening for the new vagina “the brown trousers” part of the operation.
When it happens, the best the patient can hope for is complete failure of the surgery. The hole in the bowel must stitched up and allowed to heal. It can’t stand the constant stretching the new vagina needs and the hole is allowed to close up. The dark comedy musical “Hedwig and the Angry Inch” is a direct reference to a failed vaginoplasty surgery. And that’s the best case.
The worst case scenario, the patient must have their bowels diverted to an artificial opening, called a colostomy. They have to wear a medical device to capture the contents of the bowels and may undergo multiple surgeries to repair the damage before their intestines can be reattached normally.
It’s a frightening prospect. It seemed to me that since this complication usually occurred under the knife, seeing one of the world’s top surgeons was my best bet to avoid it.
While both of these arguments are true and valid there was a deeper reason I wanted to go to Thailand. I am a romantic.
Ever since Christine Jurgensen had her SRS in the 1950’s in Brussels, transwomen have been traveling long distances for surgery. Brussels gave way to Monaco in the sixties and seventies as the Mecca of trans surgery. In the late eighties and nineties Thailand became the common destination.
Trans women have long been driven to go to great lengths to transition. Few cisgender individuals can understand the depth of our psychological need to become who we see when we close our eyes. Many literally risk everything. They risk losing jobs, they risk marriages and partnerships. They are rejected by family. They dump their entire life savings into plastic surgery. And even when they lose everything they tell you, it was worth it.
Transitioning is a leap of faith. It requires a kind of faith and resolve that few can imagine. Like most transgender people, there was a time in my life when literally everyone I knew thought I was crazy for wanting to be a woman. By the time I was considering this surgery, I had a lot of accepting people in my life. But I still knew there were more voices that said I was making a mistake than said I was doing the right thing.
We pretend that the social pressure doesn’t affect us, but it does. After all, you don’t really know what’s going to happen when you wake up. I would be lying if I said there weren’t nights when I lay awake and thought about that. What if I woke up and thought, “what have I done?” What if I hated the result? I couldn’t easily go back.
But somehow I found a tiny flame of faith in my heart, something that kept me going. My heart had been awakened to the possibility of what life could be. I was not going to let it go without a fight.
The early transsexual pioneers took incredible risks. They flew thousands of miles, spent thousands of dollars on the rumor that some doctor in some distant land had a new treatment that could help. They took such risks without hesitation because they had great faith. They knew, somehow, they could become what they were on the inside. So I took my trip to a distant land, to have surgery by a doctor that I had only met online, in part to honor their faith and in part to show my own.
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