Jeremy Wilson on the horrific risks some vulnerable people are taking by buying sex change operations on the internet.
Medical tourism is booming. Affordable international travel, improved medical standards in developing countries and gaping holes in Western healthcare systems have all contributed to internet-fuelled globalisation of the medical and cosmetic industries. It’s an international trade that can be advantageous to customers and service providers alike, but borderless medical care can have its drawbacks, too – especially when it comes to vulnerable people lured by the chance to undertake drastic and life-changing surgery on the quick and on the cheap.
Thailand has established itself as the number one destination for foreigners with gender dysphoria who are seeking reassignment surgery. Its world-class facilities are a boon for those who are ready to undertake surgery and are in a position to benefit from more choice and competitive pricing – but the thoroughness of its screening processes can leave a lot to be desired.
This being the internet age, you can browse before you buy.
By far the most common procedures are for male-to-female patients: they include breast implants, trachea shaving (in which the Adam’s Apple is removed slice by slice), laser hair removal and most importantly, genital reconstruction. There are two main techniques for this kind of surgery. The first is penile inversion, where the penis is skinned and turned inside out.
The second in colonvaginoplasty, where a section of the sigmoid colon is cut away to create a vaginal lining. The whole procedure takes just a couple of hours.
This being the internet age, you can browse before you buy and view the handywork of doctors from around the world before you get your credit card out.
The laws surrounding genital reassignment surgery in Thailand were once notoriously lax, but recently some safeguards have been introduced. Anyone wanting to change gender must now live as a woman for a year, must have taken a course of hormone treatment and must have obtained psychiatric approval.
At least, that’s the theory. Many clinics approach these laws with caveats, saying they “ideally” or “prefer to” offer surgery to those who have already lived as a woman.
People who have had surgery in Thailand remark on how easy it is to arrange. Agree a date, send a deposit and attach a note from from a psychiatrist and and a GP saying you’re fit for surgery.
How much, how young?
Finding a Thai surgeon to carry out the procedure is as as easy as Googling “sex change Thailand”, a search that yields multiple glossy websites touting the services of overseas surgeons. Many clinics offer complete packages: hotels, food and surgery.
Or you could use a medical concierge service like esteticathailandia.com, which puts together complete packages and updates their Facebook page, “Gender Reassignment Surgery Tour in Thailand”, with special offers.
For just $8,600 they can put together a two week trip to Thailand that includes airport transfers, hotels, translation services, pre-operative care, post-operative care, a penile inversion and a day excursion.
Obtaining sex reassignment surgery in a Western country varies drastically depending on where you live. If you live in the US, financial concerns will govern your choices. Ff you live somewhere with a publicly-funded healthcare system, like the UK, you may be in for a lengthy wait.
In either case, gender dysmorphia patients will be put on their countries care pathway, which will stipulate periods of psychological evaluation, time living as a member of the opposite gender and hormone treatment before permitting surgery. Western surgeons will require extensive proof that a patient has been through the pathway as opposed to the approach taken by Thai surgeons.
For many patients facing a pathway such as one provided by the UK’s National Health Service, the road ahead can seem daunting. I takes over two years to get referred to a psychiatrist, have the subsequent psychiatrist appointments, receive a diagnosis, get hormone therapy and finally be approved for surgery with a referral.
Even then, a clinical commissioning group will have to OK the operation and a surgeon will have to agree to add you to their waiting list. It’s not unknown for the whole process to take up to ten years – which is perhaps why some people are tempted to take a shortcut.
Increasing numbers of young people are being diagnosed with gender dysmorphia. According to an article in Standpoint by feminist campaigner Julie Bindel, an eighteen-month-old in Denmark was diagnosed with gender dysmorphia recently. In the the UK, a nine-year-old boy returned to school as a girl.
The minimum age for reassignment surgery in the UK and USA is eighteen years old, but other care can be offered to those not yet adults. At Children’s Hospital Boston, whose Gender Management Service treats children as young as four years old, patients are given puberty-blocking drugs at the first signs of adolescence.
An eighteen-month-old child was diagnosed with gender dysmorphia in Denmark.
In the UK, the Tavistock and Portman NHS Trust in London has obtained permission to prescribe the same drugs to youngsters from twelve years old. Between ten and twenty percent of prepubescent children with diagnosed by the clinic as having gender dysmorphia actually go on to have surgery.
Two-thirds of children diagnosed with gender dysmorphia identify as gay or lesbian later in life, which has prompted questions about how early parents and doctors are swooping in to diagnose mental or physical disorders where the most likely explanation is simply homosexuality.
Riddled with danger
While Thai doctors have an excellent reputation and many are regarded as leaders in their field, horror stories about the perils of undertaking surgery abroad in this manner are everywhere. One patient, who called herself Geri, shared this story on a popular transsexualism information website.
“I had some questions about the appearance of things and he said that it was because it was still swollen. I asked about dilation [the process of expanding a new vagina with the use of a dildo or other device to prevent distortion of its shape] and he told me not to do it for two weeks after I got home or until everything had healed. I broke down because I then knew that something was very wrong.
“Every other doctor that I had talked to told me they would have me start dilating after the packing was removed. So the doctor went and found a candle and carved it into a shape of a dilator and had them bring me a condom to put over it. That was what I was to use till I got home and got my own.
“He told me to just go buy any dildo that I could find. I was not happy about that but the damage was done now. He did not even show or tell me how I should do it when I got home, or for how long, or anything. He made me feel like, once I was out of there and on my own, it was not his problem anymore …
‘I was told to go home and be happy.’
I had my final exam on Tuesday night after dinner, when we took photos of everyone and the doctor said that everything was healing fine and that I could go home the next morning. I was given a sheet with the answers to all the questions that I had on aftercare. I told him that I was still having trouble peeing and had pain on my right side of the site.
“He never took a look at it and just said that it was swelling and would go away. I was told to go home and be happy …
“It has been four weeks since my surgery and I am having more complications. The area that was made for my clitoris has no feeling and is very pale. I still can not pee right and it is getting worse, and I have blood coming from where the sections forming the neovagina are coming apart [highly NSFW photos are here].
“I can feel the extra tissue that was left in my right labia, if you can call it that. It gives me great pain and it is still hard for me to sit. I stand most of the day. I continue to have little ‘shocks’ from the site as my brain is remapping it. I have tried to communicate with the Thai doctor about these problems and have gotten no responses.
“Dr. Ruch will not send my records to me so that I can take them to a doctor in the US.”
Horrifyingly, this woman’s story is by no means unique.
There is presently no way desperate potential patients for these services can discern between the expert surgeons operating in Thailand and dangerous hucksters. As frustrating as it can be to wait for psychological assessment back home, people unhappy with their bodies are taking outrageous risks to their mental and physical health by opting for cut-price deals on the internet.