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Sunday, September 3, 2006 - Page updated at 12:00 AM


Thailand's sex-change industry

The Associated Press

BANGKOK, Thailand — For people who believe they were born the wrong gender, the sex change they're yearning for can easily be found in this crowded capital.

The surgery is so common that it's advertised in bold print in newspaper classifieds.

Kate Monroe-Gillibrand, 50, was married for 20 years. She was Andrew then, and fathered two children.

Now in her hospital bed, days after surgery, she opens her pink satin nightgown and displays a flat bandage with a catheter. Her 73-year-old mother and her partner stand proudly at her side.

"This is a completion. This is where life begins," she says. "I'm going to stop being in a lie now."

Perhaps the least strange twist in the lurid tale of John Mark Karr, the man detained in Thailand last month after confessing in the JonBenet Ramsey murder only to have his confession debunked once back in the U.S., is that he reportedly was preparing to seek what is formally called gender-reassignment surgery in Bangkok.

A doctor said Karr went to the Siam Swan Cosmetic Clinic and its branches in Bangkok to have his sideburns and hair under his chin removed with lasers. "He wanted to prepare himself to do a sex-change operation," Dr. Setthakarn Attakonpan said.


The Harry Benjamin International Gender Dysphoria Association, Inc.:

Preecha Aesthetic Institute:

Operations are cheap and easy compared to the United States and Europe, and the city boasts some of the world's most renowned surgeons.

Dr. Preecha Tiewtranon has performed more than 3,000 male-to-female reassignment surgeries in nearly three decades.

Patients have traveled around the world for the treatment.

Preecha said Karr would have been turned away from his Aesthetic Institute, inside Bangkok's prestigious BNH Hospital. To qualify, applicants must already have been living and dressing as a woman full time and must provide at least one recommendation letter from a psychiatrist.

Patients typically book appointments in advance from their home countries and are already women in every sense, except anatomically, Preecha said.

A fraction of the U.S. cost

The majority of foreign patients come from the United States, followed by Europe and Australia. For many, it's their first trip abroad and most travel alone. Preecha performs up to 200 surgeries a year himself and estimates roughly 1,500 procedures occur annually in Thailand at his clinic and elsewhere with his students.

"The patients are so desperate to have this kind of operation," Preecha said. "The reason they come, No. 1 is because they can get good results, and No. 2 the price is low and they can afford it."

The most expensive genital reconstruction at Preecha's clinic costs $9,500, a fraction of what doctors charge in the U.S.

At the Pratunam Polyclinic, another facility said to have been visited by Karr, sex-change surgery is offered for just $1,625.

The clinic, tucked in a dingy, cramped office off a busy downtown street, also offers everything from tummy tucks to breast enlargement.

Sex-change surgery can be risky. The procedure for men becoming women takes about three hours.

Doctors shorten the urethra and use skin from the penis and scrotum to create a vagina, clitoris and labia. Possible complications include blood clots and leakage from the rectum or bladder through the newly created cavity.

Cecilia Chung, deputy director of San Francisco's Transgender Law Center, flew to Bangkok eight years ago to see Preecha. She said she paid about $8,000 for the surgery and returned home with complications that later required corrective surgery in the U.S.

"I think Asia is still one of the popular places for transgender people to seek surgery," she said by telephone. "Thailand's surgeons are readily available and they have less red tape. It's cheaper, even including airfare and hotel stay."

She said another draw is Thailand's large, open transgender community.

Optional guidelines

A few other places, including Belgium and Montreal, are popular for reassignment surgery. But Thai clinics — including in Bangkok and the resort island of Phuket — actively market such services on the Internet, said Jamison Green, a transsexual man on the board of the Harry Benjamin International Gender Dysphoria Association. The association sets guidelines for doctors with patients who want to pursue hormone therapy or surgery to change their sex.

However, no doctor is required to subscribe to the standards, which generally require two letters from mental-health professionals and proof that the patient has been living as the desired gender for a significant period before surgery.

"If people want to go outside the system to get whatever they want, they can do it," Green said in a telephone interview.

Copyright © 2006 The Seattle Times Company



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