Stages For Female To Male Sex Change Surgery in Thailand

In Thailand, the female-to-male (FTM) sex change surgery follows a similar structured approach to the procedure conducted worldwide. The process is carried out in stages to allow the body time to heal and prepare for each subsequent phase. Below is an outline of the stages involved in the FTM transition surgery in Thailand:

STAGE 1: Mastectomy & Total Abdominal Hysterectomy with Salpingo-Oophorectomy (TAHBSO)

  1. Mastectomy (Chest Reconstruction Surgery):
    • Objective: Create a masculine chest contour by removing breast tissue.
    • Procedure: The amount of tissue and skin excised will depend on the patient’s chest size and skin elasticity. Techniques such as double incision or periareolar are used depending on the patient’s anatomy.
  2. Total Abdominal Hysterectomy with Salpingo-Oophorectomy (TAHBSO):
    • Objective: Remove internal reproductive organs (uterus, fallopian tubes, ovaries).
    • Procedure: This surgery can be performed through a minimally invasive laparoscopic method or an open abdominal approach, often done concurrently with the mastectomy.

STAGE 2: Vaginectomy & Urethral Lengthening

  1. Vaginectomy:
    • Objective: Close the vaginal cavity.
    • Procedure: The vaginal lining is removed or sealed off, preparing the body for future phalloplasty.
  2. Urethral Lengthening:
    • Objective: Enable urination while standing.
    • Procedure: The urethra is extended, creating a pathway that will eventually be incorporated into the new penis during phalloplasty.
  3. Urethral Prefabrication:
    • Objective: Prepare a functioning urethra for the new penis.
    • Procedure: A skin graft is typically taken from the forearm (radial forearm flap) to create a tube with an embedded catheter, which will be integrated into the new penis.

STAGE 3: Total Phalloplasty & Scrotoplasty

  1. Phalloplasty:
    • Objective: Construct a functional penis.
    • Procedure: The penile graft prepared during the second stage (typically from the forearm or other donor site) is transferred to the genital area. Blood vessels and nerves are reconnected to provide blood flow and sensation. The penis can function for urination, and an erectile prosthesis can be inserted later to allow for sexual function.
  2. Scrotoplasty:
    • Objective: Create a scrotum.
    • Procedure: The labia majora are reshaped into scrotal sacs. Patients can opt for the insertion of silicone prosthetic testicles at this stage or in a future surgery.

Special Requirements for FTM Surgery in Thailand

  1. Psychiatric Evaluation:
    • Two letters of recommendation from psychiatrists are required, confirming:
      • Diagnosis of Gender Identity Disorder.
      • Successful real-life experience living as a male for at least one year.
      • These letters should comply with standards set by the Harry Benjamin International Gender Dysphoria Association (now known as WPATH: World Professional Association for Transgender Health).
  2. Hormone Therapy:
    • Patients must provide a medical certificate confirming that they have undergone male hormone therapy (testosterone) for at least one year under the supervision of a licensed physician.
  3. Health & Legal Requirements:
    • Patients must be in good health, both physically and mentally, and meet the legal age requirements in Thailand (18 years or older).

Post-Operative Considerations

Each surgical stage requires recovery periods of approximately 3–6 months to allow for proper healing and preparation for the next procedure. During the entire process, patients are typically advised to continue hormone therapy for masculinization, which aids in the development of secondary male characteristics such as facial hair growth, voice deepening, and increased muscle mass.

In Thailand, many hospitals and clinics that offer FTM surgeries have a well-established reputation for providing these procedures, attracting international patients due to the high quality of care, skilled surgeons, and more affordable costs compared to some Western countries.