Why trans women opt for gender confirmation surgery in Thailand whatever the cost, when procedures can be much cheaper, or free, at home
Asia travel
  • In Bangkok, Thai surgeons offer a level of world-class service lacking in Western healthcare systems, but which comes with a correspondingly hefty price tag

As Amy (not her real name) walks toward the immigration hall in Bangkok’s Suvarnabhumi Airport, she is visibly nervous. The long glass corridors, rows of fluorescent lights reflecting off plastic face shields, and sound of crinkling protective suits make her feel like she’s entered a science-fiction film.

She is presented with a small number tag and guided toward neatly spaced plastic seats where she waits for her documents to be inspected. The airport is almost completely empty.

Like an object on a conveyor belt, she has already passed through four airport checkpoints – each time she scrutinises the memory of her own documentation for one typo, one incorrectly filled form. When an immigration officer finally stamps her passport, she feels a cold wave of relief.

It is July 3, 2021, and there are reports of 6,230 new cases of Covid-19 in Thailand that day. But Amy’s anxiety is not the result of an 18-hour flight in the middle of a pandemic to a country she has never visited before. Being denied entry would create yet another stumbling block to what has already felt like a never-ending process.

She is here to receive gender confirmation surgery (GCS), a procedure she has been dreaming about since childhood and for which she has been planning for six years.

Since the first operation in 1975, Thailand has gained a reputation as the global expert in this niche field, but what is driving this industry goes well beyond the comparatively low cost of care. Over a period of six months, I spoke to a group of trans women to better understand why many would rather fly halfway across the world than receive GCS at home.

Amy in her hotel room in Bangkok. Photo: Mailee Osten-Tan

Coming from the United States, Britain, Norway, Bulgaria, Israel, Canada and Australia, and facing different personal and social circumstances, they were united in their conviction that their home countries had not presented them with good options and that they had to take matters into their own hands.


I first met Amy at the end of June 2021, 22 days before her surgery. We connected on Zoom, the hot sun streaming through the windows of my Bangkok flat, while in England, Amy sat at a desk in a dimly lit bedroom. She is not shy but I sensed an introvert, often subconsciously smoothing her long, red hair down in front of her face.

She describes understanding that she was transgender as a child in unvarnished terms: “How do you know you’re left-handed? You just do, don’t you?”

Her voice has a Yorkshire lilt, and she readily leans into her working-class identity. She tells me of an early memory watching the soap opera Coronation Street with her parents. The show featured a trans character called Hayley Cropper. That Cropper had not been assigned female at birth was something of a national sensation in the early 2000s – but not a positive one.

“All the storylines about this character were basically her getting s**t on and being abused by people,” she says. “And then I would hear people in my life mock her and be like, ‘Oh, it’s a bloke, it’s a bloke.’ … I think experiences like that at the time just increased my real desire to try to be a guy the best I could.”

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Amy thought joining the army at 19 would “make a man of her” – instead, it added to her feelings of distress and confusion. The sheer magnitude of difficulties she imagined facing by coming out had a severe effect on her mental health. She considered accepting deployment to Afghanistan a suicide bid. “I felt so fed up and low about dealing with this that I thought it wouldn’t matter if I died,” she says.


The pressures of working in a conflict zone provided some distraction, but when she returned home, in 2012, she felt just as fraught as ever. By the time she left the army, in 2014, the knowledge that she could no longer ignore her overwhelming gender dysphoria – the sense of discomfort she felt about the sex she was assigned at birth – resulted in a deep two-month depression.

Across the world, the levels of financial support trans people receive for GCS range from little or none in Bulgaria and Australia to funded fully by social healthcare systems in Britain and Canada.


In this respect, Amy should be considered lucky; as a British citizen, she qualifies for the surgery under the National Health Service (NHS). But despite relentless efforts, Amy says, she has been waiting three-and-a-half years since her first doctor’s referral.


How a transgender woman in Thailand defied stereotypes, broke barriers and found happiness

How a transgender woman in Thailand defied stereotypes, broke barriers and found happiness

Straight-talking and methodical, Amy found this process excruciating. “I like to be on time,” she says. “I like to get things done now. For someone with my personality type, it’s just been like hell.”


The pandemic has worsened her situation; nearly 6 million people in England are currently waiting for operations and procedures – a problem that has been compounding for more than a decade. “The effect of the pandemic has been to exacerbate a problem which already existed,” says James Bellringer, an NHS and private GCS surgeon in Britain for more than two decades, in an email.

But even apart from the pandemic, he writes, Britain lacks trained staff to meet the demand for surgeries. “It’s not just surgeons but the gender specialists working in the clinics. Gender has been chronically underfunded everywhere [not just in Britain] for years, and the elastic has finally snapped.”

In 2019, more than 13,500 people were waiting for treatment at NHS England’s gender identity clinics, which provide gender dysphoria assessments, prescriptions for hormones and puberty blockers, referrals for patients seeking surgery, and other services.

I am no longer proud to have served a country that cares so little for people such as myself when we need help
Amy on returning her military medals

NHS England states that patients should be able to see a non-urgent specialist within 18 weeks. Even before the pandemic, average waiting times were closer to 18 months, and in some cases, more than three years. It is no surprise, then, that many have resorted to risk self-medicating with drugs bought on the internet or seeking private care.


Amy’s military salary and tour bonus provided her with the funds she needed to begin her transition, but she didn’t have nearly enough for GCS. Knowing how much the surgery meant to her, her father insisted on dipping into his pension to pay for it.

For those who want but cannot afford surgery, or for others, the longer they are made to wait, the greater their chance of developing serious mental health issues. These often relate to the chronic high levels of stress experienced by trans people over the course of their lives – also known as minority stress – brought on by factors such as poor social support, discrimination, rejection, abuse and violence.

Most trans women I interview – including Amy – want to remain anonymous out of fear of being doxxed, harassed or targeted by hate speech. It is no wonder, then, that transgender people are more likely to attempt suicide than nearly any other social demographic.

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To cope with the administrative bureaucracy of the NHS, Amy approached her transition like a military operation. She kept records of appointments and referrals, followed up when deadlines were passed and even volunteered as a governor for her local NHS foundation trust with the hope of streamlining the system. But after years of continuous delays, faced with Kafkaesque protocols and having already spent close to £30,000 (US$36,400) in private expenses on transitioning, she found herself at breaking point in 2020.

Like countless others, she turned to the internet. Hours of research and a friend’s recommendation led her to decide on a surgeon in Thailand instead. Angered by her treatment under the NHS, she returned the medal she received for her service in Afghanistan to the government, writing in an open letter, “I am no longer proud to have served a country that cares so little for people such as myself when we need help.”

A minivan takes Amy from the airport to an upmarket hotel where she is checked into a room with a view of Bangkok. Here she spends two agonisingly slow weeks in quarantine. Two days before her operation Amy is checked out and escorted to her first consultation with Dr Kamol Pansritum at the Kamol Cosmetic Hospital, located in a northeastern suburb of the city.

Kamol is one of the most popular Thai surgeons for foreigners, and his clinic is known for its vigorous online marketing strategy. A graduate of the prestigious Faculty of Medicine, Chulalongkorn University, in Bangkok, Kamol states on his website that he has performed more than 5,000 gender confirmation surgeries since 1997.

Dr Kamol Pansritum of the Kamol Cosmetic Hospital. Photo: Kamol Cosmetic Hospital

From the windows of the minivan, Amy watches the bustle of tuk-tuks, taxis and delivery drivers on motorbikes shuttling food and parcels across the city. Along the streets leading up to the hospital, there are numerous cosmetic clinics, their window displays advertising breast augmentation, liposuction, rhinoplasty, Botox and fillers.

From the early 2000s, medical tourism was increasingly encouraged by the Thai government, which recognised an economic opportunity. By 2017, Thailand was bringing in nearly US$600 million per year from medical tourists, ranking it fifth in the world.

While transgender surgeries remain polarising in most countries, some suggest that Thailand’s attitude of tolerance for the “third gender” allowed the industry to flourish undisturbed. But this does not mean that the trans community is free from stigma.

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Thai transgender people cannot obtain legal documentation that reflects their gender identity, effectively barring them from access to vital services. Employers can demand they present according to their sex assigned at birth, and some explicitly state trans people will not be considered for job vacancies.

Thai trans people speak of discrimination in medical settings and unobtainable price points for surgery which often discourages them from seeking care altogether.

The minivan pulls up to the entrance of a whitewashed building several storeys high, heat-reflecting film tinting the windows green. Inside, a large portrait of King Rama V in full military uniform looms above the reception desk in a bright gold frame. The staff greet Amy with a wai, bowing their heads and pressing their hands together, their faces crinkling behind N95 masks.

In a small office, Kamol conducts an examination to ensure that enough tissue is available for the technique Amy has opted for. She had drafted out a list of questions but the sudden release from quarantine and the language barrier cause her to hesitate. She is reassured by his professionalism, and in many ways, feels she has already passed the point of no return.


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Once she is approved for surgery, Amy is shown into the private room where she will stay for just over a week. It is relatively modern but sterile in both senses of the word, furnished with a single bed, a pleather chaise longue, a television and curtained windows facing the building next door.

On her bedside table, she unpacks a small stack of books, a yellow Nintendo Switch and Heidi, her stuffed-toy hedgehog. She uses the free Wi-fi to video call her family, and the cleanliness of the room comforts her concerned mother, who is a palliative nurse back home.

On the day of her operation two days later, new Covid-19 cases have almost doubled to 11,305, and Amy receives the first of a number of enemas to clear out her bowels; the process makes her nauseous. Unsure as to exactly what time her surgery is scheduled for, her nerves return. She tries to keep herself distracted by reading or scrolling through social media.

Around lunchtime, she is visited by a Thai psychiatrist. This is a requirement in Thailand in addition to a written referral from a psychiatric doctor back home.

Dr Preecha Tiewtranon, the founder of the Preecha Aesthetic Institute in Bangkok and a surgeon often referred to as the “Grandfather of GCS in Thailand” for performing the country’s first gender confirmation surgery in the 1970s, tells me that the Thai assessment is more of a formality.

“Once we have the overseas approval,” he says, the chance of someone being denied the operation in Thailand is “almost zero”. As Amy informs me, “The Thai psychiatrist acknowledged it for what it was: a box-ticking exercise.”

Dr Preecha Tiewtranon, the “Grandfather of GCS in Thailand”. Photo: Mailee Osten-Tan

The World Professional Association for Transgender Health (WPATH), which sets international standards for trans healthcare, states that although psychotherapy is not an absolute requirement for people to access medical interventions, an assessment and referral by a professional with training in transgender health is essential.

This also can serve as a supportive mechanism to help patients through mental health challenges they might face as a result of social stigma. But many of the trans women I speak to tell me these evaluations reinforce the idea that being transgender is a mental illness.

They feel that the weight these psychological evaluations carry in a system of doctor referrals also patronises patients by suggesting medical professionals understand them better than they understand themselves.

Sophie from south London says she and others support a greater informed consent model of care, where the risks, liabilities and benefits are presented to the patient who is then empowered to make their own decision. As a teenager, she remembers having to play to doctors’ expectations of gender expression to get puberty blockers through the NHS.

“It was less about exploring presentation for my own sake and seeing what worked for me, and it being more like ‘OK, this is what a trans person is and this is how you have to perform that.’”

A check-up room at the Preecha Aesthetic Institute. Photo: Mailee Osten-Tan

She recalls long waiting times for appointments and invasive questioning that caused her significant distress. A few years later, when it came to surgery, Sophie’s parents were happy to pay for her to fly out to receive private care at the renowned Suporn Clinic, located 80km (50 miles) outside Bangkok, in Chonburi province, to escape what she called “mountains of bureaucracy” in her home country and “having to provide evidence of being trans”.

Her experience is echoed in a 2020 study by Mermaids, one of Britain’s leading trans charities, where more than half of young people interviewed felt, or somewhat felt, that they had to dress in a particular way to access support from their general practitioner.

Dr Abby Barras, a researcher at Mermaids, explains, “This included exaggerating more feminine or masculine traits, conforming to cisnormative expectations, such as wearing a dress or baggier clothing, and even talking in a different pitch […] clear examples of the medical gatekeeping that trans and nonbinary people often face when needing to access healthcare which is not inclusive or affirming.”

Feeling the need to present “proof” of being trans is the result of a not-too-distant past, where a psychological or medical diagnosis of “transsexualism” was mainstream, almost always referring to someone who is seeking hormones or surgical transition.

The term implies that people must fit within the male/female binary – that is to say, be either male or female – through having taken surgical action. This differs from today’s more common use of the word “transgender”, an umbrella term that acknowledges that gender self-expression and gender dysphoria can be present in different ways. WPATH accordingly changed its guidelines to better recognise transition as a non-linear path, and that some people may not want hormonal or surgical treatments.

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For those who do opt for the surgical route, vaginoplasty (also known as “bottom surgery”) is one of several transfeminine surgeries available, which also include breast augmentation and facial feminisation.

Across the North Sea from Sophie, Yui’s home country of Norway has only one authorised provider of tax-funded healthcare for trans people – the National Treatment Centre for Transsexualism (NBTS) – which, as the name suggests, continues to use diagnostic terminology and approaches. Every year, the NBTS rejects around 75 per cent of referrals.

After many months of waiting, Yui says she was told by an NBTS specialist to come back in a year, when she had made more “progress” with her transition, such as wearing make-up and dressing more femininely. She was also quizzed at length about her sexual preferences.

“They asked what my sexuality was and if I had had sex, how many times, how I felt having sex,” she says. Later, she learned that the questions were optional and for research purposes but this had not been made clear to her at the time. She had thought her answers would determine whether she qualified for medical treatment, and, if that were the case, it would have been an irrelevant line of questioning.

Yui in her hotel room in Chonburi, near Bangkok, as she awaits gender confirmation surgery. Photo: Mailee Osten-Tan

Gender identity has nothing to do with sexuality; not all trans women will categorically hate having a penis or will only want to engage in sexual relations with men. Assessing gender dysphoria through the lens of sexual activity also recalls a time when being trans was erroneously considered a form of sexual deviancy.

Yui eventually resorted to seeing a private doctor to start hormone treatment. “The NBTS are insanely gatekeeping. It’s only cis people that will pass their standards for trans, so a lot of people will lie to get through the initial meeting,” she says. Visually impaired and relying on government welfare, Yui had to take out significant loans to cover her GCS in Thailand instead.

While many of the intended beneficiaries of psycho­logical and medical evaluations report them to be a model of policing, medical experts remain divided. GCS is a major procedure resulting in permanent fertility loss – it is not to be taken lightly.

Speaking from Perth, Australia, Curtin University associate professor Sam Winter, a leading academic in transgender health, explains, “No surgeon wants to be in a situation in which they do the surgery and a couple of years down the line are being sued. There is a reluctance on the part of surgeons to engage in the work that they do without some sort of professional reassurance. The assurance from a clinical assessment by a mental health professional gives them confidence.”

Reports of people who detransition, or those who reverse their transgender identification or gender transition, don’t help. The amount of media and public attention these reports receive generates a false perception that many trans people experience post-operative regret.

There is a very ugly underbelly to trans medicine. Some surgeons have rose-coloured glasses on because all of a sudden they’re realising how much money they can make
Dr Christine McGinn, GCS surgeon, Papillon Gender Wellness Centre in the US

A recent study suggests that less than 1 per cent of patients who have undergone transfeminine and transmasculine surgeries regret their decision. Other research reports that those who do often do not regret undergoing the procedure itself but rather the poor results they receive.

At 5pm, a nurse who cheerfully refers to Amy as “sister” wheels her to the operating theatre. Around nine operating staff in green gowns pause to greet her. There are bright lights and two sets of monitor screens, metal tables with instruments laid out in neat rows.

The anaesthetist makes cheerful small talk in broken English about being a Liverpool football fan. Amy doesn’t have the heart to tell him that she’s not from Liverpool. An oxygen mask is lowered over her face; within seconds, she’s out.

Penile inversion vaginoplasty has been the main method of transitioning to female since the mid-20th century, and is still considered by many surgeons to be the gold standard. But the penile inversion technique felt dated to Amy, and that’s why she is at this clinic.

Of the handful of other techniques available, peritoneal pull-through (PPT) is newer and trendier, although not as widely tested or performed on trans women as penile inversion. PPT originated in gynaecology to reconstruct cisgender women’s vaginas using tissue from the lining of the abdominal cavity, which has some moisture-producing properties.

Using the peritoneum in GCS was popularised by Dr Lee Zhao at New York University in recent years, and Kamol is one of the few surgeons in the world performing PPT. Amy found out about the technique online.

To perform PPT, small incisions are made in Amy’s belly through which the peritoneal tissue – which lines the abdominal wall and covers most of the organs in the abdomen – is released. The space between the rectum and urinary tract is dissected, and the peritoneal tissue is then pulled down into the space between the rectum and the urethra to serve as the vaginal lining.

A catheter is inserted, and the testicles are removed. The penis is carefully dissected, using the shaft and scrotal skin to create the labia while the glans at the top of the penis becomes the new clitoris. The whole process takes around five to six hours.

Some patients are drawn to PPT because it provides surgeons with more material to put toward vaginal depth, though penile inversion vaginoplasty does provide patients with depth akin to that of a natal vagina.

After the operation, Amy will need to use dilators for at least the first year to keep the vaginal canal open, with most patients needing to dilate once or twice a month for the rest of their lives.

Amy’s dilation kit. Photo: Mailee Osten-Tan

Dr Min Jun, a surgeon in northern California who works primarily with the robotic peritoneal flap vaginoplasty technique, says that the peritoneal tissue also helps provide stability since it can be attached to the surrounding tissue – something that is much more difficult to do in penile inversion. But PPT can lead both to additional recovery time and time spent under anaesthesia.

Jun feels that the peritoneal tissue’s lubricating properties are somewhat overplayed online since the peritoneum does not respond to sexual stimuli and fluid production diminishes with time.

“There’s probably 10 different ways to do gender confirming surgery,” says Dr Christine McGinn, a GCS surgeon who founded the Papillon Gender Wellness Centre in the 2000s, in the US state of Pennsylvania, and who is a trans woman herself. “With peritoneal pull-through, it has to be tested. It has to be peer reviewed. The thing with trends like these is it’s a chance for patients to feel more powerful and self-confident in their choice.”

Like Amy, some patients’ suspicions around penile inversion stems from a conviction that this field has seen a lack of innovation since the 1960s, and the belief that the advancement of transgender surgery is not something the healthcare industry at large considers important. While the robotic peritoneal flap vaginoplasty method Jun is working on is arguably one of the most innovative the field has seen in years, the process uses a machine that costs upwards of US$1 million, making it much more expensive.

The decision about which technique works best for each patient ultimately depends on what is feasible in terms of available tissue, age, pre-existing health conditions and cost. Done well, neo-vaginas in all their variations can be almost aesthetically indistinguishable from natal ones.

Yui shows her dilators. Photo: Mailee Osten-Tan

Innovation is the least of some patients’ concerns. Even the tried-and-tested penile inversion technique comes with risks, heightened by the fact that the success of the surgery still relies almost entirely on the skill and experience of the individual surgeon. Doctors must be able to painstakingly dissect tissue with sensitive nerve endings to provide patients with a vagina that not only looks but functions like a natal vagina.

One of the priorities of modern GCS is the ability for post-operative patients to enjoy physical intimacy. Since the highly sensitive glans found at the tip of the penis is refashioned as the clitoris, research suggests that most successful operations result in trans women being able to reach orgasm.

Despite the high stakes, in the US, surgeons are not required to have extensive specialist training or certifications in GCS. Insurance coverage for transgender surgeries increased after the Affordable Care Act made discrimination based on gender identity unlawful in 2010.

Though insurance policies for GCS still vary widely depending on the state and insurance provider, coverage became more common, and surgeries increased fourfold between 2000 and 2014.

“There is a very ugly underbelly to trans medicine,” says McGinn. “Some surgeons have rose-coloured glasses on because all of a sudden they’re realising how much money they can make.”


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There are few to no standardised rules – WPATH guidelines state a requirement for surgeons to be “qualified” but that term is loosely defined. McGinn says that while some engage in longer apprenticeships with established surgeons, training in GCS can be as short as a week of mere observation.

Dr Curtis Crane, a GCS surgeon in Austin, Texas, who opened his practice in 2012, adds, “GCS is all the rage now and so we see surgeons getting into an area they weren’t trained in […] I see results from surgeons that weren’t, in my opinion, trained as well as they should have been and that are experimenting and just hoping that they get a good result.” Policies in the US often limit patients to consulting surgeons within their state, closing off other options.

When surgery is handled by an inexperienced or incompetent surgeon, the outcome can be disastrous. In 2020, the Jezebel website reported shocking surgical results at the hands of Dr Kathy Rumer, a US surgeon.

I spoke to one of her former patients, Hannah Simpson, who developed early signs of necrosis – the death or decay of body tissue due to limited blood flow – which began about a week after surgery.

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She says Rumer dismissed her concerns, initially insisting that there was nothing wrong. Simpson ended up having another surgery with a new doctor to try to fix the damage, but it only made things worse. Her clitoris necrosed. Since 2015, Simpson says she’s had consultations with dozens of doctors in 10 countries to figure out how to reconnect the nerve endings she lost through the procedure.

In the months after I talked to her, she went through the first stage of a revision surgery. It’s currently unclear to what extent it will help.

“I am left with a Picasso interpretation of a vagina that is missing constituent elements,” she says. “I’m a sexual person who wants to desire in sexuality and who is missing the pieces her body needs.”

Unfortunately, Simpson is one of many. Despite multiple allegations of medical misconduct from various patients over recent years, Rumer has yet to face any significant legal consequences. Rumer declined to comment to Jezebel.

It is understandable that many trans women feel more comfortable in the care of someone who has completed hundreds of successful GCS surgeries. Thailand’s long medical history specialising in GCS remains one of the main attractions for foreign patients from across the world.

Preecha went on to train many of the surgeons who are still practising today, including Dr Chettawut Tulayaphanich, Dr Suporn Watanyusakul and Amy’s surgeon, Kamol. Yet despite Thailand’s popularity – and as with surgeons all over the world – there is never a 100 per cent guarantee of success.

The Preecha Aesthetic Institute in Thailand. Photo: Mailee Osten-Tan

Maria Creveling, better known as Remilia, was a professional US Twitch streamer who received gender confirmation surgery from an unnamed Thai surgeon in 2018. The procedure left her with nerve damage in her pelvic area and excruciating pain. In December 2019, aged 24, she was reported to have died in her sleep – although the official cause of her death is still unknown.

In August 2021, I spoke to New Yorker Justine Wiles, who called me from her hotel room in central Bangkok while recovering from surgery with Chettawut at the Chettawut Plastic Surgery Center. She had worked several jobs, including one at Starbucks, to cover the cost and had chosen Thailand after being inspired by transgender activist Janet Mock’s journey through GCS.

“When I went to Dr Chettawut’s office for my surgery, I saw his degrees and all of his certifications displayed on his walls from 1997 – when I was born – and that gave me comfort.”

Justine had at first to convince her family to let her go. They were concerned that the quality of care she would receive abroad would not be as high as that in the US, which is a common misconception given television shows such as Botched.

Using state-of-the-art hospital facilities that rival Western options, Thailand’s top surgeons attracting foreign patients are known for their exemplary skill and expertise. “Thai surgeons are amazing,” says Crane in Texas. “You know, they’ve been doing it for a long time and there’s such a huge healthcare community there.”

Some patients are especially drawn to Suporn and his protégé, Dr Chayamote “Bank” Chyangsu, for their reputation as perfectionists. The Suporn Clinic was repeatedly cited to me by trans patients as one of the best places for GCS in the world.

I had people saying to me, ‘Just wait until 2022 because Covid will be all gone then.’ But you don’t know that. I wasn’t going to do that because I don’t trust that anything will stay the same any more

The Suporn Clinic offers free “cosmetic improvements’’ or revisions. Including flights, surgery at the Suporn Clinic can, however, cost up to US$25,000, which likely makes Suporn’s the most expensive GCS option in Thailand. Despite shying away from self-promotion and the media, spots for surgery at the Suporn Clinic often fill up within hours of becoming available.

“This is your one body,” says Rae, a trans woman from Canada who asked to use a pseudonym. She decided to opt out of GCS under publicly funded healthcare in favour of surgery with Suporn over a year ago. “I understand a lot of people don’t have the funding […] But for me, I don’t buy knock-off laptops or knock-off iPhones. I buy the iPhone. I want the No 1.”

Three days after Amy’s surgery, I call to check how she’s doing. It’s the first time she’s sitting up in bed since the operation and the nurses have propped her up on a couple of pillows. She is wearing the same tightly chequered, red-and-white hospital gown from the day of her surgery. “I look terrible,” she says, staring at herself on Zoom.

Her words slur a little; she has recently been administered morphine. Her operation seems to have gone well, but she has a lot of healing to do before she can make an accurate assessment. She hasn’t seen the results yet, and is a little wary. With the stitches, bruising and swelling, it won’t be pretty.


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For now, her feelings are primarily of relief. “When I woke up, I could feel that my anatomy was different,” she says. “That being said, though, it feels quite normal that it is different. Like, I don’t think I’ve had some great moment of transcendence. My body just clicked and it was like, ‘This feels how it should feel.’

“I had male anatomy for 30 years, but I was lying in bed thinking to myself, ‘So what does it feel like to have a penis?’ I can’t even conceptualise that now. It’s so strange.”

Patients spend the days following surgery in bed on high doses of pain medication. Few of the women I spoke to could recall much from that time, except Yui, who remembers vomiting from the anaesthesia.

Lily, an American patient who had her surgery with Suporn in 2018 and asks not to use her real name, describes the packing being removed from the surgical site seven days after the operation as “the magic handkerchief trick. You know when a magician pulls silk out of a hat? [The nurse] pulls the packing out of you and it just keeps going and going and going.”

After a week in the hospital, Amy is discharged and transferred to a hotel affiliated with the Kamol Clinic, just 200 metres down the road. Off the beaten tourist track and with many prospective patients postponing their surgeries due to Covid-19, the hotel is almost completely empty.

Post-op patients are advised not to embark on any strenuous activity if the pain on its own is not enough of a deterrent. Still hooked up to a catheter, Amy recalls with dark amusement how she spent a couple of days carrying around a little bag of her own urine.

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Outside on the street, there is not much of interest except a Pizza Company restaurant and a small, well-tended garden next to the hotel. Although she sees a couple of other patients from Asian countries, the language barrier once again stands in the way of any meaningful conversation.

Twice daily she walks slowly back to the hospital for check-ups and nurse-assisted dilation; her first session after the operation reduces her to tears, but with each day, the sessions become a little less painful.

She finds herself crying more often than usual, coupled with hot flushes, which she partially attributes to having stopped hormone replacement therapy. Patients are instructed to discontinue their HRT treatment around three weeks before surgery, and not to restart again until a few weeks post-op.

When I visit Amy up in her hotel room, she confides she perhaps underestimated how much stress having the surgery under pandemic conditions would put on her. Family and friends had advised her to postpone it, but the pandemic had only hardened her resolve.

“I had people saying to me, ‘Just wait until 2022 because Covid will be all gone then.’ But you don’t know that. I wasn’t going to do that because I don’t trust that anything will stay the same any more.”

This story first appeared in longreads.com