Beautiful 'Man'
Tour guide undergoes televised sex change after single psychiatric check, lifetime of waiting
Story by Tul Pinkaew
Bangkok Post, December 11, 2004, Page 1
The boy wearing blue, and little girl in pink, the journey to manhood and womanhood - for many people it is all settled at a baby shower months before a child is born.
From adolescence to adulthood, people live out their lives according to the gender roles society assigns them, based on their sex.
Some, however, want to break the mould. Nathanan wanted to become a woman spiritually and physically and underwent a sex change operation beamed live yesterday to international experts. She undertook the procedure after just one psychiatric evaluation.
"Since I can remember, I have always wanted to be a woman and I have been saving money for this sex change operation since I graduated from university," said Nathanan.
Working as a tour guide, Nathanan said her only meeting with a psychiatrist took place about a month ago in which the doctor took one look at her and said she was ready for the life-changing process.
"It was obvious how I felt about my sexuality and the doctor saw it straight away.
Now 27, Nathanan has been taking female hormones in the form of birth control pills since the age of 15.
"There is no doubt in my mind that I needed to be rid of my male sex organs, and my family supported me," she said.
The operation, which was televised on a closed circuit system to an audience of 12 international doctors, a world's first for this kind of procedure, was performed by Dr Preecha Tiewtranon, known to his colleagues as the godfather of sex reassignment. The hospital said the operation was a success and the patient can leave hospital in seven days.
"Twenty-five years ago I pioneered the practice in this country and performed sex change operations on Thais First. But in the past five years 90% of the cases have come from overseas," he said.
Dr Preecha said he has performed more than 2,600 sex reassignments. Westerners, he said, came to the Preecha Aesthetic Institute, at BNH Hospital, because of its relatively low cost, 300,000 baht (about US$ 7,500) for a sex change operation, and high standard of treatment.
"For Thais just one psychiatric consultation is enough to evaluate whether he or she is ready for the sex change," the doctor argued.
Dr Preecha said Thai transvestites look feminine because they are able to acquire female hormones at a young age without a prescription.
"The hormones change the skin complexion, the metabolism of the body. That's why they are so beautiful. There's really no need for a consultation at all and we have never had a case of any of our patients wanting a reversal," he said.
For foreign patients, however, he needed to see all the paperwork to avoid any kind of legal mishap.
Sherri-Ann Higgins, a married 56-vear-old grandfather from Pittsburgh whose daughter found out about Dr Preecha's institute on the internet, said the process back home took too long.
"To prove your competence in the US you have to go through therapy for two years. Then take female hormones for a year and also testosterone blockers as well as dress as a woman before you are cleared to have sex change surgery," Ms Higgins said. When they make the decision to change, most people want to get through it fast, she said.
SRS in Thailand
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hkeunuch (imported)
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Leona Lee (imported)
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Re: SRS in Thailand
Hey Pre-Op TG/TS Girls! This article is a Happy one for Nathanan. While we all eat our hearts out. O well, Nice article.Hugs,Leona 
For the Girls
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hkeunuch (imported)
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Re: SRS in Thailand
Here is some information on these operations that I copied from the hospital's website: www.bnhHospital.com (http://www.bnhhospital.com/).
Having lived in Bangkok myself, I can say that it is amongst the top 3 most trusted hospitals for expatriates and foreigners. But I have no knowledge of this doctor or his department.
Bilateral Orchiectomy (BO)
Fact about procedure
Bilateral orchiectomy is the surgical removal of both testicles, not the removal of the scrotum.
Surgery is performed by Dr. Preecha Tiewtranon M.D., Plastic and Reconstructive Surgeon, American Board Certified in 1973, Associate Professor of Plastic and Reconstructive Surgery in the King Chulalongkorn University, Faculty of Medicine in Bangkok, Thailand, also the former President of the Society of Plastic and Reconstructive Surgeons of Thailand and President of the Society of Aesthetic Surgeons of Thailand, Member of the International Society of Plastic and Reconstructive Surgery.
Criteria of Approval
Patient must be at least age 18 years of age. Patients will require permission from parents if under 20 years old.
Patients must be diagnosed with at least one of the following disorders:gender identity disorder, gender dysphoria, or associated conditions.
Patients must have undergone at least one year of antiandrogens or/and female hormones.
Patients are required to have lived full-time in the cross-gender role for at least 1 year (supported by Identification Documents) if need.
Duration of Operation
One and a half hour
Recovery Time
You need to stay in hospital one night. If you are an international pateint.
You need to stay in Bangkok 5 days for post-op cares.
Surgery Schedule Detail
Patient need to be in hospital private room one night inclusived.
Patient need to be in Bangkok 5 more days after surgery for post-op cares.
Total time in Bangkok 6-7 days after surgery.
Penile Skin Inversion / Vaginal Plasty
Fact about procedure
Dr. Preecha started SRS or GRS in 1978 about 30 years ago, all the SRS surgeons in Thailand were trained by him. Now he had done about 3,000 cases of Male to Female SRS, 130 cases of Female to Male, 350 cases of sigmoid- color vaginoplasty and many thousands of aesthetic surgery in Male Transexuals.The technique used is Penile Skin Inversion, the sensational glans clitoris, labiaplasty and vaginoplasty in one stage with 3 different technique.
1. Long Penis (>6 inches) = Penile Skin Inversion (PSI)
2. Medium Penis (2-6 inches) = PSI with Scrotal Skin Graft (SSG)
3. Short Penis (<2 inches) = PSI with Sigmoid Colon Graft (SCG)
Conclusion, only Penile Skin Inversion is US$6,500. With Penile Skin Inversion and Sigmoid Colon is US$8,400
Criteria of Approval
Patient must be at least age 18 years of age. Patients will require permission from parents if under 20 years old.
Patients must be diagnosed with at least one of the following disorders:gender identity disorder, gender dysphoria, or associated conditions.
Patients must have undergone at least one year of antiandrogens or/and female hormones.
Patients are required to have lived full-time in the cross-gender role for at least 1 year (supported by Identification Documents).
Patients must have approval from a psychiatrist (MD), psychiatric social worker (PhD), or clinical psychologist (PhD).
Surgery is performed by Dr. Preecha Tiewtranon M.D.
Surgical procedure
The M to F, SRS surgery is as followed:
Creation of vaginal space between urethra, prostate gland, bladder and rectum
Bilateral orchietomy
Degloved penis shaft
Separation of urethra from penis
Isolation glans penis with 2 dorsal nerves and vessels
Penile skin inversion to line vaginal cavity with or without scrotal skin graft or sigmoid colon graft
Clitoroplasty (Sensate)
Urethropalsty
Labiaplasty, major and minor
A portion of the glans (head of the penis), with its nerves and vessels, is converted into a clitoris. In so do, the clitoris will be functional in sensation as well as in appearance.
The excess erectile tissue around the urethra should be removed in order to avoid symptoms that stem from engorged erectile tissue during sexual arousal, that may result in the narrowing of the vaginal opening.
Colon transposition is used for patients who need more depth (exceeding 8 inches).
As of 2002, Dr Preecha has performed over 550 of successful colon transposition operations.
Technique
There are 3 main techniques
Penile skin Inversion (PSI) only (for the long penis)
Penile Inversion with scrotal skin graft. (PSI plus SSG for medium size penis)
Penile Inversion with Sigmoid Color Graft. (PSI plus SCG for Tiny, small size penis)
The SSG or SCG is done in one stage with 5 days hospitalization (average).
Results
The Male to Female SRS is done in one stage with result of
a. Sensate Glans- Clitoris
b. Neourethra
c. Vulva Floor
d. Labia major and minor
e. Neovagina of 5-6 inches (Natural Vagina is 4.5 inches)
Duration of Operation
2.30- 3.00 Hours
Possible Risks and Complications
1.Infection; Usually only minor wound infection. There are no pulmonary or
systemic infection.
2. Wound disruption; Only at the fourchet of the new vagina perineum due to high tension at the area, will require only wound care and heal spontaneously in one month.
3. Short Vagina; Normally you will get the depth of 5- 6 inches, at first, depth will be deeper after 6- 12 months due to the maturation of scar and yield more elasticity. In case of very short vagina, the second operation can be done after 6 months, by using the sigmoid colon procedure, which will cost $8,500 with the same recovery plan.
4. Rectovagima Fistula; where a hole develops between the colon and the vagina.There were 3 out of 1000 + cases all were well taken care of.
The other complications which were mentioned in the literatures such as the urethra vaginal fistula, Pulmonary thromboembolism, extensive bleeding, serious infection have never occurred in his experience.
Surgery Schedule Detail
DAY 1
Arrive in Bangkok International Airport. Meet PAI staff and be escorted to the hospital.
Pre-surgery night in the private deluxe suite in Hospital
DAY 2
Meet with your appointment doctor for clinical interview / surgical consultation.
All questions will be clarified personally and the surgery technique will be discussed and interview with Psychiatric tests (if necessary)
Check medical documents
Admission to hospital. You will be requested to sign hospital consent forms.
The operation date and time will be arranged within twenty-four hours after
Pre-operative consultation.
On the day:
The nurse will do complete enema to clean rectum.
Take very nice shower.
Preoperative intravenous fluid and sedation.
In operating room under general anesthesia.
Surgery takes about three hours
DAY 3-5 The day after:
Upon waking up, able to have regular meal, and move freely in bed. Do not be alarmed by the catheter for urine and drainage tube full of blood, this is normal at first, it will stop in twenty-four hours. You may feel like you want to urinate, but it is not, due to the urine catheter irritation. Pain is usually minimum only during the first twenty-four hours. Then subsided gradually, you can be ambulated with help daily. The dressing gauze and the catheter will be removed on the 4th- 5th days. You can urinate take a shower and to be discharged back to hotel on the 5th day. A nurse will come and bath you twice a day and change your bedding as often as necessary
DAY 6
Your doctor will remove the dressing and bandages. Upon checking the results you may leave the hospital and check in to your chosen hotel.
DAY 6-10
These five days should be spent for resting
DAY 11
You may go to Sightseeing or Shopping (Depend on doctor diagnosis).
DAY 12
If you were at your chosen hotel. Please return to the hospital where the doctor will remove sutures from the labia and do a final examination. You will receive a final postoperative recovery check up and some medications. You will also receive a medical certificate that authenticates the surgery and recommends that you receive a legal change of sex.
DAY 13
Transfer to Bangkok International Airport for Departure by PAI staff.
Having lived in Bangkok myself, I can say that it is amongst the top 3 most trusted hospitals for expatriates and foreigners. But I have no knowledge of this doctor or his department.
Bilateral Orchiectomy (BO)
Fact about procedure
Bilateral orchiectomy is the surgical removal of both testicles, not the removal of the scrotum.
Surgery is performed by Dr. Preecha Tiewtranon M.D., Plastic and Reconstructive Surgeon, American Board Certified in 1973, Associate Professor of Plastic and Reconstructive Surgery in the King Chulalongkorn University, Faculty of Medicine in Bangkok, Thailand, also the former President of the Society of Plastic and Reconstructive Surgeons of Thailand and President of the Society of Aesthetic Surgeons of Thailand, Member of the International Society of Plastic and Reconstructive Surgery.
Criteria of Approval
Patient must be at least age 18 years of age. Patients will require permission from parents if under 20 years old.
Patients must be diagnosed with at least one of the following disorders:gender identity disorder, gender dysphoria, or associated conditions.
Patients must have undergone at least one year of antiandrogens or/and female hormones.
Patients are required to have lived full-time in the cross-gender role for at least 1 year (supported by Identification Documents) if need.
Duration of Operation
One and a half hour
Recovery Time
You need to stay in hospital one night. If you are an international pateint.
You need to stay in Bangkok 5 days for post-op cares.
Surgery Schedule Detail
Patient need to be in hospital private room one night inclusived.
Patient need to be in Bangkok 5 more days after surgery for post-op cares.
Total time in Bangkok 6-7 days after surgery.
Penile Skin Inversion / Vaginal Plasty
Fact about procedure
Dr. Preecha started SRS or GRS in 1978 about 30 years ago, all the SRS surgeons in Thailand were trained by him. Now he had done about 3,000 cases of Male to Female SRS, 130 cases of Female to Male, 350 cases of sigmoid- color vaginoplasty and many thousands of aesthetic surgery in Male Transexuals.The technique used is Penile Skin Inversion, the sensational glans clitoris, labiaplasty and vaginoplasty in one stage with 3 different technique.
1. Long Penis (>6 inches) = Penile Skin Inversion (PSI)
2. Medium Penis (2-6 inches) = PSI with Scrotal Skin Graft (SSG)
3. Short Penis (<2 inches) = PSI with Sigmoid Colon Graft (SCG)
Conclusion, only Penile Skin Inversion is US$6,500. With Penile Skin Inversion and Sigmoid Colon is US$8,400
Criteria of Approval
Patient must be at least age 18 years of age. Patients will require permission from parents if under 20 years old.
Patients must be diagnosed with at least one of the following disorders:gender identity disorder, gender dysphoria, or associated conditions.
Patients must have undergone at least one year of antiandrogens or/and female hormones.
Patients are required to have lived full-time in the cross-gender role for at least 1 year (supported by Identification Documents).
Patients must have approval from a psychiatrist (MD), psychiatric social worker (PhD), or clinical psychologist (PhD).
Surgery is performed by Dr. Preecha Tiewtranon M.D.
Surgical procedure
The M to F, SRS surgery is as followed:
Creation of vaginal space between urethra, prostate gland, bladder and rectum
Bilateral orchietomy
Degloved penis shaft
Separation of urethra from penis
Isolation glans penis with 2 dorsal nerves and vessels
Penile skin inversion to line vaginal cavity with or without scrotal skin graft or sigmoid colon graft
Clitoroplasty (Sensate)
Urethropalsty
Labiaplasty, major and minor
A portion of the glans (head of the penis), with its nerves and vessels, is converted into a clitoris. In so do, the clitoris will be functional in sensation as well as in appearance.
The excess erectile tissue around the urethra should be removed in order to avoid symptoms that stem from engorged erectile tissue during sexual arousal, that may result in the narrowing of the vaginal opening.
Colon transposition is used for patients who need more depth (exceeding 8 inches).
As of 2002, Dr Preecha has performed over 550 of successful colon transposition operations.
Technique
There are 3 main techniques
Penile skin Inversion (PSI) only (for the long penis)
Penile Inversion with scrotal skin graft. (PSI plus SSG for medium size penis)
Penile Inversion with Sigmoid Color Graft. (PSI plus SCG for Tiny, small size penis)
The SSG or SCG is done in one stage with 5 days hospitalization (average).
Results
The Male to Female SRS is done in one stage with result of
a. Sensate Glans- Clitoris
b. Neourethra
c. Vulva Floor
d. Labia major and minor
e. Neovagina of 5-6 inches (Natural Vagina is 4.5 inches)
Duration of Operation
2.30- 3.00 Hours
Possible Risks and Complications
1.Infection; Usually only minor wound infection. There are no pulmonary or
systemic infection.
2. Wound disruption; Only at the fourchet of the new vagina perineum due to high tension at the area, will require only wound care and heal spontaneously in one month.
3. Short Vagina; Normally you will get the depth of 5- 6 inches, at first, depth will be deeper after 6- 12 months due to the maturation of scar and yield more elasticity. In case of very short vagina, the second operation can be done after 6 months, by using the sigmoid colon procedure, which will cost $8,500 with the same recovery plan.
4. Rectovagima Fistula; where a hole develops between the colon and the vagina.There were 3 out of 1000 + cases all were well taken care of.
The other complications which were mentioned in the literatures such as the urethra vaginal fistula, Pulmonary thromboembolism, extensive bleeding, serious infection have never occurred in his experience.
Surgery Schedule Detail
DAY 1
Arrive in Bangkok International Airport. Meet PAI staff and be escorted to the hospital.
Pre-surgery night in the private deluxe suite in Hospital
DAY 2
Meet with your appointment doctor for clinical interview / surgical consultation.
All questions will be clarified personally and the surgery technique will be discussed and interview with Psychiatric tests (if necessary)
Check medical documents
Admission to hospital. You will be requested to sign hospital consent forms.
The operation date and time will be arranged within twenty-four hours after
Pre-operative consultation.
On the day:
The nurse will do complete enema to clean rectum.
Take very nice shower.
Preoperative intravenous fluid and sedation.
In operating room under general anesthesia.
Surgery takes about three hours
DAY 3-5 The day after:
Upon waking up, able to have regular meal, and move freely in bed. Do not be alarmed by the catheter for urine and drainage tube full of blood, this is normal at first, it will stop in twenty-four hours. You may feel like you want to urinate, but it is not, due to the urine catheter irritation. Pain is usually minimum only during the first twenty-four hours. Then subsided gradually, you can be ambulated with help daily. The dressing gauze and the catheter will be removed on the 4th- 5th days. You can urinate take a shower and to be discharged back to hotel on the 5th day. A nurse will come and bath you twice a day and change your bedding as often as necessary
DAY 6
Your doctor will remove the dressing and bandages. Upon checking the results you may leave the hospital and check in to your chosen hotel.
DAY 6-10
These five days should be spent for resting
DAY 11
You may go to Sightseeing or Shopping (Depend on doctor diagnosis).
DAY 12
If you were at your chosen hotel. Please return to the hospital where the doctor will remove sutures from the labia and do a final examination. You will receive a final postoperative recovery check up and some medications. You will also receive a medical certificate that authenticates the surgery and recommends that you receive a legal change of sex.
DAY 13
Transfer to Bangkok International Airport for Departure by PAI staff.