Who is the candidate for female-to-male (FTM) sex reassignment surgery?
Patients must receive a diagnosis of either gender identity disorder, gender dysphoria, or related problems such as anxiety or depression.
What are the prerequisites for undergoing female-to-male (FTM) sex reassignment surgery?
Patients must undergo uninterrupted hormone therapy for a duration of 12 months and furnish a valid prescription from a physician for the hormone treatment.

Patients must demonstrate 12 consecutive months of successful full-time real-life experience in the gender role opposite to their assigned sex. Additionally, they must produce an identity document from a registered psychiatrist (MD).
What is the necessity of undergoing hormone therapy?
Hormonal therapy is a crucial component of the gender transition process, impacting both the physical and psychological aspects. These procedures are frequently deemed medically essential to enable individuals to live in accordance with their preferred gender identity.
What is the necessity of having a consecutive period of 12 months where I have achieved consistent achievement in full-time real-life activities?
The real-life experience refers to the complete embrace of a new or developing gender role or gender presentation in one’s daily existence. This step is crucial in an individual’s gender transition. It is a significant decision that impacts not just the individual, but also their immediate family, relatives, friends, and colleagues. Due to the immediate and significant impact on individuals and society, it is crucial to have a clear understanding of the familial, vocational, interpersonal, educational, economic, and legal outcomes.
Are there any post-treatment ramifications following testosterone administration?
Testosterone medication can provide both beneficial effects and adverse consequences. The beneficial outcomes of testosterone therapy include vocal cord thickening resulting in a deeper voice, clitoral growth, slight reduction in breast volume, heightened growth of facial and body hair, and the onset of male pattern baldness. Possible adverse effects of females include infertility, acne, emotional instability, elevated sexual drive, alteration of lipid profiles towards male patterns, which heightens the risk of cardiovascular disease, potential development of benign or malignant liver tumors, and liver dysfunction. Given these adverse effects, it is imperative that patients adhere to the guidance of their physician when taking hormones.

Will I be able to conceive a kid with my partner after the surgery?
The penis of a transgender male is constructed from soft tissue from the forearm, which differs from the specialized tissue and testicular composition seen in the penis of a cisgender male. Therefore, the transgender male is unable to conceive a kid with his spouse.
What is the recommended duration for staying in Thailand for sex reassignment surgery?
For optimal recuperation, it is recommended that patients remain in Thailand for a minimum of 2-3 weeks during the initial two stages, and one month for the last step. Typically, it is advisable for a patient to spend their first night in a hotel upon arriving in Thailand in order to recuperate after a lengthy travel and prepare for surgery the following day. The hospitalization for female-to-male sex reassignment surgery is contingent upon the specific stage of the patient’s transition.
What is the preoperative preparation advice?
Prior to undergoing surgery, it is imperative that you abstain from smoking tobacco products, ingesting alcohol, and taking any prescriptions or vitamins for a minimum of 2 weeks. Furthermore, it is imperative that you observe an 8-hour fasting period before to the surgery, during which you must abstain from consuming any food on the day of the procedure.
What is the procedure for performing surgery?
The process of female-to-male (FTM) sex reassignment surgery involves three distinct stages, with each stage spaced 3-6 months apart to provide adequate healing:

Phase 1: Mastectomy and hysterectomy:

Subcutaneous mastectomy, often known as breast reduction surgery, effectively decreases breast size and imparts masculine characteristics to the patient’s breasts.

Hysterectomy surgery involves the removal of the uterus and ovaries, which effectively resolves issues related to menstruation and also eliminates the hormone-producing organs.

Duration of hospital stay: 6 nights
Duration of visit to Thailand: 2 weeks

Stage 2 involves two procedures: vaginal closure and urethral extension, as well as urethral prefabrication.

Vaginal closure and urethral lengthening involve modifying the urinary tract by closing the vaginal opening. Due to the differing orientations of the female and male urinary tracts, the surgeon must modify the direction of the urinary tract and fully shut the vagina. In the final step, the urethra is elongated and readied to connect with the urethra at the forearm.

Urethral prefabrication is carried out to ready the urethra for attachment to a penis utilizing the forearm flap Phalloplasty technique. The skin, nerves, and blood arteries from the forearm are elevated and subsequently transplanted. The recovery period for this step will last around 3 months until the urethra, which is being built in the forearm, is prepared for the next stage.

Duration of hospital stay: 7 nights
Duration of visit in Thailand: 2 weeks

Phase 3: Construction of the male genital organ (phalloplasty):

This stage involves the construction of the male genital organ by transferring a flap of skin from the forearm and connecting the structures using microsurgical techniques. A penis length of approximately 4-6 inches can be achieved, depending on the length of the patient’s forearm. The surgeon dissects the blood arteries and nerves of the forearm in order to establish connections with the blood vessels and nerves in the pubic region. Subsequently, a scrotal sac is constructed using the tissues derived from the labia. The scrotal sac is comprised of adipose tissue and pigmented skin from the labia, but does not contain testicles.

Duration of hospital stay: 14 nights
Duration of visit in Thailand: 1 month
What does post-surgical care entail?
Similar to other significant surgical procedures, individuals who have undergone sex reassignment surgery should refrain from engaging in physically demanding activities. Adhere to the surgeon’s postoperative instructions for a period of 3-4 weeks.
What are the potential hazards and adverse effects?
Adhering strictly to the surgeon’s advice will minimize the likelihood of dangers and problems. The primary potential hazards include edema, contusion, hemorrhage, infection, cicatrization, and paresthesia, or alteration in sensory perception.