Thailand's Capital Is Becoming SRS Center
By Karl Vetas
Salon Magazine
Old-timers recall that in the 1970s -- before someone clued the owners on the
proper spelling -- tailoring establishments were emblazoned with signs
reading "Man Chop." In retrospect, the signs were either far ahead of
their time or were on the wrong shops.
Visitors still shop Bangkok for inexpensive, well-tailored suits, and
stores along Sukhumvit Road's side streets still advertise "suit, three
shirts, vest, safari suit, two extra pairs of pants, only $100." And as in
the past, it isn't until you get into the shop that you discover the $100
covers only the tailoring; you pay extra -- a lot extra -- for the cloth.
It is only appropriate, then, that Bangkok is rapidly gaining
recognition for a new type of alteration. In gay and lesbian circles, the
city is known as a "gender reassignment center." Translated into plain
English, this means sex change operations. This is a vacation where on
your return home friends can exclaim, "My, your holiday did wonders for you;
you look completely different," and mean it.
This is not a shady back-alley business but one performed by some
of the city's best plastic surgeons, in their own clinics, in hospitals or
in university medical centers. As a result, Bangkok has become a magnet
for transsexuals from Europe, Asia and the United States
It seems highly fitting that Bangkok should enjoy its present fame.
It is a town where nothing is quite as it seems, where one can assume a new
identify, a new persona. It is a city where the Khon, the masked
dance/drama, is considered the supreme art form. In the City of Angels (as
its Thai name "Krung Thep" translates) one can rent a gorgeous woman for
the night and discover in the hotel room that the "lady" has handles and
faucets. Little wonder that it is possible to assume more than a psychic
disguise; for a little cash, one can match it with a physical alteration.
But the more salient reasons for the massive influx of transsexuals
have to do with professional skill, cost and ease in getting approval
for the operation. Already known for their skills in reshaping faces,
Thailand's plastic surgeons have had more than 20 years to gain their
considerable expertise in "gender reassignment" surgery. And they offer it
at a price far lower than in a patient's own country.
"In Bangkok, you can change sex from male to female for only
$7,000; it would cost at least $15,000 at home," says Dr. Preecha
Tiewtranon, one of the art's foremost practitioners. He does two
male-to-female operations each week at Bangkok's prestigious Chulalongkorn
University Hospital, "for demonstration purposes to medical students."
In addition, he performs 20 operations per month at his Chollada
Clinic in the city's heart. The clinic sits down Soi 1 off busy Sukhumvit
Road in a modest townhouse that gives little hint of the activities that
take place within. It is presided over by an avuncular man nearing 60 who,
with his horn-rimmed glasses, looks less like a medical doctor and more
like a bureaucrat.
Preecha's main line of work is facial adjustments and breast
augmentation. His waiting room is filled primarily with Thais who seem
quite happy with their natural gender assignment, although a few await
transformation from males to "lady boys" and will find employment in gay
bars. But he also has more than 600 male-to-female transformations to his credit, with most of his
patients coming from the United States, Europe and the elsewhere in Asia.
"Most of my clients are foreigners," he says. "They come here
because the laws in their countries are very strict and the waiting period
for approving the operations can often be three years. Here in Thailand,
there's a protocol that says one needs to spend two years to see if the
operation will be appropriate." What he doesn't say -- but what everyone knows -- is
that Thai laws are lax; there is no waiting period if the doctor and
patient feel the time is right.
The laxity of the laws stems in part from a social acceptance of
gays of any persuasion, local or foreign. Gays play a major role in Thai
social life, many of them presiding over soirees at large hotels. At one
major hotel, the British general manager takes off his suit each day at 5
p.m. and dons a wig and a gown for an evening on the town.
In the past 25 years, the nation has had two reputedly gay prime ministers.
And at the moment, a "katoey" (transvestite) professional "muay Thai" (Thai
kick-boxing) boxer is famous for entering the ring wearing make-up. This is not a gimmick
but a statement; once the fists and feet begin pummeling, you know that he
is in deadly earnest. Nor is his ferocity a reaction to ill treatment:
Gays have always been accepted in Thailand; the idea of "gay-bashing" is an alien concept in the Land of Smiles.
Gender orientation or reorientation is even recognized in the
nation's bill of rights. The newly promulgated constitution allows those
who have undergone sex alterations to change their gender on certain legal
documents.
Although Thai laws are applied liberally, Preecha lays down strict
guidelines for those seeking to change their gender.
"My advice is that if a male wants to be a female, he should A)
dress like one for a year, B) take hormones for six months to reduce the
male features and hair, and C) undergo an assessment by a
urologist/gynecologist to see if the operation is right. This doctor must also
explain to the patient everything that is involved. Unfortunately, most
patients don't want to wait; they want it done now."
Using the latest techniques, Thai surgeons normally complete the
operation in 90 minutes. In the past, the skin used to create the new
vagina was taken from the inner thigh, but this technique was abandoned because
the grafts left unsightly scars and the skin proved not to be very
flexible. "Penal skin is very elastic, so we use that skin to line the
inner walls of the vagina," says Preecha. The resultant vagina is
remarkably realistic and the penis head shaped into a small clitoris is
sensitive to touch.
Foreign patients also note the level of care as a key reason for
undergoing male-to-female operations in Bangkok. Clinics are antiseptic and
have the latest equipment and a high caregiver-to-patient ratio. A
typical operating team includes the doctor, an anesthetist and five
nurses. In the university demonstrations (which cost less because the
subject -- called a "service patient" -- serves as a teaching tool) the doctor
may be assisted by several interns.
As a result, complications are low. Not that it would matter;
there are no malpractice suits because patients are required to sign
consent waivers absolving the surgeon of all responsibility for slip-ups.
While he is adept at male-to-female operations, Preecha balks
at female-to-male transformations. "It is a very difficult operation and
foreign patients generally have too high expectations. They want
everything to be as it is in nature -- but this just isn't possible."
Foreigners, he says, arrive thinking they can simply walk into the
clinic a woman and come out a man. "It takes at least four operations to
re-shape the female genitalia and create a penis from the skin covering the
abdomen. You can't do them a week apart; sometimes you have to wait six
months for the previous operation to heal.
"And they are expensive, nearly $100,000. Most foreigners don't have the
money or the time to stay here for the two years it usually takes. They
also don't have the money to come back time and again for the next
procedure," he claims. "For these reasons, I don't do these types of
operations anymore."
Many female-to-male operations fail because they involve use of a
small $3,000 pump that allows the patient to erect his new penis. The
pumps are notoriously unreliable, with a high failure rate. Even if it
does work, the patient can satisfy his partner but not himself.
Yet foreigners continue to flood into Thailand, seeking both types of
operations. In "Amazing Thailand," as the tourism authorities are billing
the country this year, they can purchase new genders as easily as they once
bought suits. Except that with this alteration, the customer supplies the
fabric.
SALON | Sept. 10, 1998
Karl Vetas writes about Asia for a variety of publications.
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